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Founded 1836 

U. S. Department of Health, Education, and Welfare 

Public Health SerTice 




O F 




Profefibr of the Pradlice of Phyfic in the Univerfity of Edinburgh ^ 
Firft Phylician to his Britannic Majefby for Scotland ; 
Fellow of the Royal College of Phyficians of Edinburgh ; 

Of the Royal Societies of London and of Edinburgh, 
Of the Royal Society of Medicine of Paris, &c, &-:. &c, 


From the Laft British Edition, 

Revised, CoRRECTEDand Enlarged, by the Author. 


Vol. I^^j^' 

— *S^m.. 



PRINTED at fro /iC£5r£i?, Massachusetts, 

Sold at his RooKSTtKE in WORCESTER, and by him and 
Company in BOSTON. 



C O N T E N T S'- 




Of exanthema- 


OJ the Small Pox - - 15 


OJ the Chicken Pox - - 44. 


Cj/" ({Ac Measles - - - 46 

OJ the ScAHLET Fever — - 55 

G H A P 



OJ the Plague „ - - C)4 

Seft. I. OJ the Phenomena of the 

Plague - - ~ '^ 

Sea. II. 0/ the Prevention of the 
Plague - - - 07 

Sea. "III. 0/ihe Cure 0/ the Plague 74 


Of Zky SI? EL AS, or St. Anthonfs Fire 78 


Of the Miliary Fever - - 86 


Of the remaining Exanthemata : 
Urticaria, Pemphigus, and Aph- 
tha - - - 97 






(?/ Hemorrhagy m^^n^r^^ - loo 

Se^. I. Of the Phenomena of Hemor^ 
rhagy - " - - - ^02 

Seft. II. Of the Proximate Caufe of 

Hemorj'hagy - - - 104 

Seft. in. Of the Remote Caufes of 
Hemorrhagy - - 124 

Sea. IV. Of the Cure of Hemorrhagy 126 


Of the Ep 1ST AX IS, or Hemorrhagy of 
the Nofe - - - MO 


Of the Hemoptysis, or Hemorrhagy 
from the Lungs - - - ^S-i 

Sed. I. Of the Phenomena and Caufes 
of Hemoptyfis - - - ^5^ 

SzQc. II, Of the Cure of Hemoptyfis 160 




OJ the Phthisis Pulmonalis, or Con^ 
fumption of the Lungs , - - 164 

Se6l. I. Of the Phenomena and Caufes 
of the Phthifis Pulmonalii - 164 

Sea. II. Of the Cure of Phthifts 193 

C H A P. V. 

Of the Hemorrhois, or of the Hemor- 
rhoidal Swelling and Flux - 207 

Seft. I. Of the Phenomena and Caufes 
of the Hemorrhois - 207 

Sea. II. Of the Cure of HemorrJioidal 
AJfedions _ _ 218 



Of the Menorrhagia, or the Immod- 
erate Flow of the Menfes _ 228 

CHAP. vn. 




f"} - 



i ■Of the Amenorrhoea, or Interruption 

of the Menjlrual Flux - 242 


i CHAP. IX. 

u 0/" Symptomatic Hemorrhagies 253 

Seft. I. Of the Hematemesis, or 
Vomiting of Blood - 254 

Se6l;. II. Of the Hematuria, or the 

Voiding of Blood from the Urinary 
Pajfage - - 264 

B O O K V. 


jil PYREXIA - - 273 


Of the Catarrh - - 275 


Of the Dysentery - - 287 


25/ EASES . - 30t 







Of Apoplexy - - 3°4 


0/ Palsy - - - 333 



LOSS OF MOTION in either 
THE VITAL or natural 
FUNCTIONS - - 350 


OJ S)Yti CO? Zy ■or Fainting - 350 

C H A P. IL 

0/ Dysfef SI Ay or Indigejiion. - 363 

C H A P. III. 

Of Hypochondriasis, or the Hypo^ 
chondriac Affection, commonly called 
Vapours or Low Spirits - 3,82 








HE difeafes comprehended 
under this title, which make 
the third Order of Pyrex- 
iae in our Nofology, are 
in general fuch as do not a- 
rife but upon occafion of a 
specific contagion applied, 
which firft produces fever, and afterwards an 
*^^' II' B eruption 



eruption upon the furface of the body ; and 
which difcafes, for the moft part, affeft per- 
fons but once in the courfe of their lives. 


Whether the charafter of the Order may- 
be thus Hmited, or if the Order may be al- 
lowed to comprehend alfo the eruptive fevers 
produced by a matter generated in the body 
itfelf, and hkewife thofe cafes of eruption 
which do not depend upon contagion, or up- 
on a matter generated before the fever, but 
upon a matter generated in the courfe of the 
fever, I am not ready to determine. Of the 
difeafes enumerated by the Nofologifts as 
Exanihematay there are certainly three differ- 
ent kinds, whicli may be diflinguiflied by the 
circumftances mentioned in this and the pre- 
ceding paragraph. Of the firft kind are th<e 
Small Pox, the Chicken Pox, the Meafles, 
the Scarlet Fever, and the Plague. Of the 
fecond kind feems to be the Eryfipelas ; and 
of the third kind I judge the Miliaria and 
Petechia to be. But as I am not fufficiently 
■confident in the fads which fhould fupport 
thefe diflinaions, or which would enable us 
to apply them in all cafes ; I go on in this 
book to treat of almoft all the exanthemata 
enumerated by preceding Nofologiflis, wifih 
only fome difference in the arrangement from 
what it was in my former, editions. 




C H A P. 


I DLxxxvn. . 

c. 1 HE fmall pox is a diTeafe 

tk-arifing from a contagion of a fpecific nature, 
prt.which fir ft produces a fever, and on the third or 
t'jfourth day thereof, produces an eruption of 
iSt; fmall red pimples. Thefe are afterwards form- 
feed into puftules, containing a matter, which, 
jt^in the courfe of eight days from the time of 
jDjthe eruption, is changed into pus. After this, 
entl^he matter dries, and falls off in crufts. 



This is a general idea of the difeafe ; but 
^yiji;here are two particular forms or varieties of 
fjojt, well known under the appellations of the 

DiJUnB and Confcuent, which require to be 

pecially defcribed. 

^^' B2 DLXXXIX. 



In the former, or the diftin£l fmall pox, the 
eruptive fever is moderate, and appears to be 
evidently of the inflammatory kind, or what 
we name a Synocha. It generally comes on 
about mid day, with fome lymptoms of a cold 
flage, and commonly with a confiderabie lan- 
guor and drowfinels. A hot ft age is foon 
formed, and becomes more confiderable on 
the fecond and third days. During this 
courfe, children are liable to frequent ftartings 
from their flumbers ; and adults, if they are 
kept abed, are difpofed to much fweating. 
On the third day, children are fometimes af- 
fe£led with one or two epileptic fits. To- 
wards the end of the third day, the eruption 
commonly appears, and gradually increafes 
during the fourth ; appearing firft upon the 
face, and fuccelTively on the infeiior parts, fo 
as to be completed over the whole body on 
the fifth day. 

From the third day the fever abates ; and 
againft the fifth it entirely ceafes. The erup- 
tion appears firft in fmall red fpots, hardly 
eminent, but by degrees rifing into pimples. 
Thefc are generally upon the face in fmall 
number ; but even when more numerous, they 
are feparate and diftinft from one another. 
On the fifth or fixth day, a fmall veficle, con- 
taining an alm.oft colourlefs or whey coloured 
fluid, appears upon the top of each pimple. 



For two days,there veficles increafe in breadth 
only, and there is a fmall hollow pit in their 
middle ; fo that it is only againll the eighth 
day that they are raifed intoYpheroidical puf- 

Thefe veficles' or pu-ftules, from their firft 
formation, continue to be furrounded with an 
exa6lly circular inflamed margin, which, when 
the puilules are numerous, diffufes feme in- 
flammation over the neighbouring {km, fo as 
to give fomewhat of a damailc rofe colour to 
the fpaces between the puftules. As the puf- 
tules increafe in fize, if they be numerous on 
the face, againft the eighth day the whole of 
the face becomes confiderably fwelied ; and 
in particular, the eyelids are fo much fv/elled 
as entirely to (hut the eyes. 

As the difeafe thus proceeds, the matter in 
the puftules becomes by degrees more opaque 
and white, and at length of a yellowifh colour. 
On the eleventh day, the fwelling of the face 
is abated, and the puftules feem auite full. 
On the top of each a darker fpot^ appears ; 
and at this place the puftule, on the eleventh 
day, or foon after, is fpontaneoufly broken, 
and a portion of the matter oozes out ; in 
confequence of which, the puftule is Ihrivei- 
led, and fubfides ; while the matter oozing out 
dries, and forms a cruft upon its furface. 
Sometimes a little only of the matter oozes 
out ; and what remains in the puftule becomes 
thick, and even hard. After fome days, both 
the crufts and the hardened puftules fall off, 
B 3 leavint^ 


leaving the fkin which they covered of a brown 
red colour ; and it is only after many days 
that the fkin in thefe places refumes its nat- 
ural colour. In fome cafes, where the matter 
of the puflules has been more liquid, the crafts 
formed by it are later in falling off, and the 
part they covered fuffer fome defquamation, 
^\rhich leaves in it a fmall pit or hollow. 

This is the courfe of things on the face ; 
and fucccffively, the puflules on the refl of the 
body take the fame. The matter of the puf- 
tules, on the arms and hands, is frequently 
abforbed ; fo that,, at the height of the difeafe, 
thefe puflules appear as empty veficles. On 
the tenth and eleventh days, as the fwelling 
of the face fubfides, a fwelling arifes in the 
hands and feet ; but which, again, fubfides as 
the puflules come to maturity. 

When the puflules on the face are nume- 
rous, fome degree of pyrexia appears on the 
tenth and eleventh daj's, but difappears again 
after the puflules are fully ripened ; or per- 
haps remains in a very flight degree till the 
puflules on the feet have finifhed their courfe. 
It is feldom that in the diflindl fmall pox the 
fever continues longer. 

When the puflules on the face are nume- 
rous, fome uneafmefs in the throat, with a 
hoarfenefs of the voice, comes on upon the 
fixth or feventh day, and a thin liquid is 
poured out from the mouth. Thefe fymp- 
toms incrcafe with the fwelling of the face ; 
and the liquids of the mouth and throat be- 


coming thicker, are more difficultly thrown 
out. There is, at the fame time, lorae diffi- 
culty of fwallowing ; fo that liquids taken in 
to be fwallowed are frequently rejefled, or 
thrown out by the nofe. But all thefe affec- 
tions of the fauces abate as the fwelling of the 
face fubfides. 


In the other form of fmall pox, or what is 
called the Confluent, the courfe of the difeafe 
is, in general, the fame with that we have de- 
fcribed ; but the fymptoms of every flage are 
more violent, and feveral of the circumftanccs 
are different. 

In particular, the eruptive fever is more 
violent ; the pulfe is more frequent and more 
contrafted, approaching to that ff ate of pulfe 
which is found in the typhus ; the coma i.s 
more confiderable ; and there is frequently a 
delirium. Vomiting, alfo, is a common fj-mp- 
tom, efpecially at the comingonof thedifeafe. 
In very young infants, epileptic fits are fome- 
times frequent on the firft days of the difeafe, 
and fometimes prove fatal before any eruption 
appears ; or they ufher in a very confluent 
and putrid fmall pox. 


The eruption appears more early on the third' 

day,,and it is frequently preceded or accom- 

B 4 panied- 


panied with an eryfipelatous efflorefcenre. 
Sometimes the eruption appears in cluflers, 
]ike that of the meafles. When the eruption 
is completed, the pimples are always more nxi- 
merous upon the face, and at the fame time 
fmaller and lefs eminent. After the eruption, 
the fever fufFers fome remiffion, but ne^-er goes 
off entirely ; and, after the fifth or fixth day, 
it again increafes, and continues confiderable 
through the remaining. courfe of the difeafe. 

The veficles formed on the tops of the 
pimples appear fooner ; and while they in- 
creafe in breadth, do not retain a circular, but 
are every way of an irregular figure. Many 
oF them run into one another, infomuch that 
very often the face is covered rather with one 
veficle than with a number of puftules. The 
I'eficles, fo far as they are any wife feparated, 
do not arife to a fphf^roidical form, but re- 
rnain flat, and fometimes the whole of the face 
is of an even furface. When the puflules are 
in any meafure feparated, their circumference 
is not bounded by an inflamed margin, and 
the part of the fldn that is free from puftules 
is commonly pale and flaccid. 

The liquor that is in the puflules changes 
from a clear to an opaque appearance, and be- 
comes whitifh or brcwnifli, but never acquires 
the yellow colour and thick confiftence that 
appear in the diftiuft fmall pox. 




The fwelliag of the face which attends the 
diftin6l fmall pox, when they are numerous, 
and almofl then only, always attends the con- 
fluent, comes on more early, and arifcs to a 
greater degree ; but abates on the tenth day, 
and on the eleventh ftill more. At this time 
the puflules or velicles break, and fhri veiling 
pour out a liquor that is formed into brown 
or black crulls, which do not fall off lor many 
d'ays after. Thole of the face, in falling oif^ 
leave the parts they cover fubje£l to a del- 
quamation^ which pretty certamly produces 

On the other parts of the body, the puflules 
of the confluent fmall pox are more diflinft 
than upon the face, but never acquire the lame 
maturity and conliftence of pus as in the 
properly diflinft kind. 

The falivation which only fometimes at- 
tends the diflin6l fmall pox, very c^nllantly 
attends the confluent ; andboth the falivation 
and the aff^etlion of the fauces aboveraen- 
tioned are, efpecially in adults, in a higher 
degree. In infants, a diarrhoea comes fre- 
quently in place of the falivation. 

In the confluent fmall pox, there is often a 
confiderable putrefcency of the fluids, as ap- 
pears from petechias, from ferous vehcles, uur- 
der which the fkin fhows a difpofition to gan- 
grene, and from bloody urine or other hem- 

VoL. 2. B 5 orrhagy^ 


on-hagy, all which fymptoms frequently ac- 
company this difeafe. 

In the confluent fmall pox, the fever, which 
had only fufFered a remiffion from the time of 
eruption to that of maturation, is often, at or 
immediately after this period, renewed with 
confiderable violence. This is what has been 
called the Secondary Fever ; and is, in differ- 
ent cafes, of various duration and event. 


We have thus endeavoured to defcribe the 
various circumftances of the fmall pox ; and 
from the difference of thefe circumftances, the 
event of the difeafe may be determined. The 
whole of the prognofis may be nearly com- 
prifed in the following propofitions. 

The more exaftly the difeafe retains the 
form of the diftin6l kind, it is the fafer ; and 
the more completely the difeafe takes the form 
of the confluent kind it is the more dangerous. 

It is only when the diflintt kind fhows a 
great number of puftules on the face, or oth- 
erwife, by fever or putrefcency, approaches to 
the circumffances of the confluent, that it is 
attended with any danger. 

In the confluent fmall pox there is always 
danger ; and this is always more confiderable 
and certain, according as the fever is more vi- 
olent and permanent, and efpecially as the 
marks and fymptoms of putrefcency are more 


0"= F P H Y s r C. 23 

When the putrid difpofition is very great, 
the difeafe fometimes proves fatal before the 
eighth day ; but in moll cafes it is on the 
eleventh that death happens, and fometimes it 
is put oflF till the fourteenth or feventeenth 

Though the fmall pox fhould not be im- 
mediately fatal, the more violent kinds are 
often followed by a morbid flate of the body, 
of various kind and event. Thefe confe- 
quences, as I judge, may be imputed fome-. 
times to an acrid matter produced by the pre- 
ceding difeafe, and depofited in different 
parts ; and fometimes to an inflammatory di- 
athefis produced, and determined to particu- 
lar parts of the body. 


It is, I think agreed among praftitioner^, 
that, in the different cafes of. fmall pox, the 
difference chiefly depends upon the appear- 
ance of diftinft or confluent ; and, from the 
above defcription of thefe kinds, it will ap- 
pear, that they chiefly differ in the period of 
the eruption, in the number of puftules 
produced, in the form of the puflules, in the 
ftate of the matter contained in them, in the 
continuani^e of the fever, and laftly in the 
danger of the difeafe. 

B6^ DXCV.. 



Upon inquiring into the c^ufes of thefe 
differences, we might readily fufpeft, that 
they depended upon a difference of the con- 
tagion producing the difeafe. This, howev- 
er, is not probable ; for there are innumerable 
inftances of the contagion, arifmg from a per- 
fon labouring under the fmall pox of the d-if- 
tinft kind, producing the confluent ; and on 
the contrary. Since the praftice of inocula- 
tion became frequent, we have known the 
fame variolous matter produce in one perfon 
the diftindl, and in another the confluent 
fmall pox. It is therefore highly probable, 
that the difference of the fmall pox does, not 
depend upon any difference of the contagion, 
but upon fome difference in the ftate of the 
perfons to whom it is applied, or in the flate 
of certain circumftanccs concurring with the 
application of the contagion. 


To find out wherein the difference in the 
ftate of the perfons to whom the contagion of 
the fmall pox is applied confifl;s, I obferve, 
that the difference between the diflinft and 
confluent fmall pox confifl:s efpecially in the 
number of puflules produced; which, in the 
diftinft, are generally few ; in the confluent 
always many. If, therefore, we fliall be able 



to difcover what^ in the flate of different per- 
fons, can give occafion to more or fewer puf- 
tules, we (hall probably be able to account for 
all the other differences of the diftin6l and 
confluent fmall pox. 


It is evident, that the contagion of the 
fmall pox is a ferment with refpefl to the hu- 
man fluids, and afTimiiates a great part of 
them to its own nature ; and it is probable, 
that the quantity thus afTimilated, is, in pro- 
portion to the bulk of their feveral bodies, near- 
ly the fame in different perfons. This quan- 
tity paffes again out of the body, partly by in- 
fenfible perfpiration,, and partly by being de- 
pofited in puftules ; but if the quantities gen- 
erated be nearly equal, the quantities pafHng 
out of the body by the two ways mentioned 
are very unequal in different perfons ^ and 
therefore, if we can explain the caufes which 
determine more to pafs by the one way than 
by the other, we may thereby difcover the 
caufes which give occafion to more puflules in 
one perfon than in another. 


The caufes which determine more of the 
variolous matter to pafs by perfpiration, or to 
form pulliiles, are probably certain circum- 
ftances of the fkin, that determine more or 


25 P R A C T I C E 

lefs of the variolous matter to flick in it, or 
to pafs freely through it. 


The circumflance of the fkin, which feems 
to determine the variolous matter to flick in 
it, is a certain flate of inflammation, depend- 
ing much upon the heat of it : Thus we have 
many inflances of parts of the body, from be- 
ing more heated, having a greater number of 
pullules than other parts. In the prefent 
pra6lice of inoculation, in which few puflules 
are produced, much feems to be owing to the 
care that is taken to keep the fkin cool. 
Parts covered with plallers, efpecially with 
thofe of a flimulant kind, have more puflules 
than other parts. Further, certain circum- 
ftances, fuch as adult age, and full living, de- 
termining to a phlogiflic diathefis, feem to 
produce a greater number of puflules ; while 
the contrary circumflances have contrary ef- 


It is therefore probable, that an inflamma- 
tory flate of the whole fyflem, and more par- 
ticularly of the fkin, gives occafion to a great- 
er number of puflules ; and the caufes of this 
may likewife produce mofl of the other cir- 
cumflances of the confluent fmall pox ; fuch 
as the period of eruption j the continuance of 



the fever ; the efiFufion of a more putrefcent 
matter, and lefs fit to be converted into pus ; 
and what arifes from thence, the form and oth- 
er circumftances of the puflules. 


Having thus attempted to account for the 
chief difference which occurs in the ftate of 
the fmall pox,, we fhall now try the truth of^ 
our do6lrine, by its application to pra6lice, 


In confidering the pra6lice, we view it firft,, 
in general, as fuited to render the difeafe more 
generally benign and fafe, and this by the 
praftice of inoculation. 


It is not neceflary here to defcribe the op- 
eration of inoculating ; and what we name the 
pra£lice of inoculation, comprehends all the 
feveral meafures which precede or follow that 
operation, and are fuppofed to produce its 
falutary effefts. 

Thefe meafures are chiefly the following. 

1 . The choofmg for the fubje6l of inocu- 
lation perfons otherwife free from difeafe, and 
not liable, from their age or other ciHCum- 
ftances, to any incidental difeafe. 

2. The 


2. The choofing a perfon at the time of 
life moft favourable to a mild difeafe. 

3. The choofing for the praaice a feafon 
the moft conducive to the mildnefs of the 

4. The preparing the perfon to be inocu- 
lated, by abftinence from animal food forfome 
time before inoculation. 

5. The preparing the perfon by courfes of 
mercurial and antimonial medicines. 

6. The taking care, at the time of inocula- 
tion, to avoid cold, intemperance, fear, or oth- 
er circumftances which might aggravate the 
future difeafe. 

7. After thefe preparations and precautions, 
the choofing a fit matter to be employed in 
inoculation, by taking it from a perfon of a 
found conftitution, and free from any difeafe 
or fufpicion of it ; by taking it from a perfon 
who has had the fmall pox of the moft be- 
nign kind ; and, laftly, by taking the matter 
from fuch perfons, as foon as it has appeared 
in the puftules, either in the part inoculated, 
or on other parts of the body. 

8. The introducing, by inoculation, but a 
fmall portion of the contagious matter. 

9. After inoculation, the continuing the 
vegetable diet, as well as the employment of 
mercurial and antimonial medicines ; and, at 
the fame time, frequently employing purga- 

10. Both before and after inoculation talk- 
ing care to avoid external heat, either from 


O F P H Y S I C. 29 

the fun, artificial fires, warm chambers, much 
clothing, or being much in bed ; and, on the 
contrary, expofing the perfon to a free and 
cool air. 

1 1. Upon the appearance of the eruptive fe- 
ver, the rendering that moderate by the em- 
ployment of purgatives ; by theufe of cooling 
and antifeptic acids ; and efpecially by expof- 
ing the perfon frequently to a cool and even a 
cold air, at the fame time giving freely of cold 

12. After the eruption, the continuing the 
application of cold air, and the ufe of purga- 
tives, during the courfe of the difeafe, till the 
puflules are fully ripened. 


Thefe are the meafures propofed and prac- 
tifed in the latefl; and mod improved flate of 
inoculation ; and the advantages obtained by 
the whole of the praftice, or at leaft by moll 
of the meafures abovementioned, are now af- 
certained by a long experience to amount to 
this, That, in ninety nine cafes of the hun- 
dred, inoculation gives a diftinft fmall pox 
only, and that alfo very generally of the mild- 
eft form ; but it will ftill be ufeful, for the 
proper conduft of inoculation, to confider the 
importance and utility of the feveral meafures 
abovementioned, that we may thereby more 
exa6lly determine upon what the advantages 
of inoculation more certainly depend. 





As the common infeftion may often fei'ze 
perfons labouring under another difeafe, 
which may render the fmall pox more violent, 
it is obvious that inoculation muft have a 
great advantage, by avoiding fuch concur- 
rence. But as the avoiding fuch concurrence 
may often, in the mean while, leave perfons 
expofed to the common infeftion, it merits 
inquiry, whether every difeafed ftate ftiould 
rellrain from the praftice of inoculation, or 
what are the particular difeafes that fhould do 
fo. This is not yet fufficiently afcertained by 
obfervation ; and we have frequently remark- 
ed, that the fmall pox have often occurred 
with a difeafed ftate of the body, without be- 
ing thereby rendered more violent. In par- 
ticular, we have obferved, that a fcrophulous 
habit, or even the prefence of fcrophula, did 
not render the fmall pox more violent ; and 
we have obferved alfo, that feveral difeafes of 
the fkin are equally innocent. I am of opin- 
ion, that they are the difeafes of the febrile 
kind, or ailments ready to induce or as^gravate 
afebrile ftate, that efpecially give the concur- 
rence which is moft dangerous with the fmall 
pox. I dare not attempt a-ny general rules ; 
but I am difpofed to maintain, that though a 
perfon be in a difeafed ftate, if that ftate be of 
uncertain nature and eff'ed, and at the fame 
time the fmall pox be exceedingly rife, fo as 


to render it extremely difficult to guard againft 
the common infedion, it will always be fafer 
to give the fmall pox by inoculation, than to 
leave the perfon to take them by the common 


Though inoculation has been praaifed with 
fafety upon perfons of all ages ; yet, from what 
has adually occurred in the cafes of common 
infeaion, and from feveral other confidera- 
tions, there is realbn to conclude, that adults 
are more liable to a violent difeafe than perfons 
of younger years. At thelfeme time, it is ob- 
ferved, that children, in the time of their firft 
dentition, are liable, from this irritation, to 
have the fmall pox rendered more violent j 
and that infants, before the time of dentition, 
upon receiving the contagion of the fmall pox, 
are liable to be afFeaed with epileptic fits, 
which frequently prove fatal. It is therefore, 
upon the whole, evident, that though circum- 
ftances may admit, and even render inocula- 
tion at any age proper ; yet, for the moft part, 
it will be ftill more advifable to choofe per- 
fons at an age, after the firft dentition is over, 
and before the time of puberty. 


Though inoculation has been praaifed 
with fafety at every feafon of the year ; yet. 



as it is certain that the cold of winter may 
increafe the inflammatory, and the heats of 
fummer increafe the putrefcent ftate of the 
fmall pox, it is highly probable that inocula- 
tion may have fome advantage, from avoiding 
the extremes either of heat or cold. 


Although the original temperament and 
conftitutions of men are not to be readily 
changed ; it is fufficiently certain, that the 
conditions of the human body may, by va- 
rious caufes, in many refpefts be occafionally 
very much changed ; and therefore, as the ufe 
of animal food may increafe both the inflam- 
matory and putrefcent ftate of the human 
body, fo it muft render perfons, on receiving 
the contagion of the fmall pox, lefs fecure a- 
gainft a violent difeafe ; and, therefore, inoc- 
ulation may derive fome advantage from ab- 
ftinence from animal food for fome time be- 
fore the inoculation is performed ; but I am 
of opinion, that a longer time than that ufual- 
ly prefcribed may be often neceflary ; and I 
am perfuaded, that the Scottifli mothers who 
avoid giving their children animal food till 
they are pa ft the fmall pox, render this difeafe 
in them of a milder kind. 


I cannot deny that mercurial and antimo- 
siial medicines may have fome efFe6l in deter- 


mining to a more free perfpiration, and there- 
fore may be of fome ufe in preparing a per- 
fon for the fmall pox ; but there are many ob- 
fervations which render me doubtful as to 
their efFed. The quantity of both thefe 
medicines, particularly of the antimony, com- 
monly employed, is too inconfiderable to pro- 
duce any effeft. It is true, that the mercuri- 
als have often been employed more freely ; 
but even their falutary effcas have not been 
evident, and their mifchievous efFe6ls have 
fometimes appeared. I doubt, therefore, 
upon the whole, if inoculation derives any 
advantage from thefe pretended preparatory 
courfes of medicines. 


As it has been often obferved, in the cafe 
of almoft all contagions, that cold, intemper- 
ance, fear, and fome other circumftances, 
concurring with the application of the co'nta- 
gion, have greatly aggravated the future dif- 
eafe, fg it mufl be the fame in the cafe of the 
fmall pox ; and it is undoubted, that inoc- 
ulation muft derive a great, and perhaps its 
principal, advantage, from avoiding the con- 
currences abovementioned. 


It has been commonly fuppofed, that inoc- 
ulation hai derived fome advantage from the 




choice of the matter employed in it ; but, 
from what has been obl'eiTed in DXCV, it 
mult appear very doubtful if ^ny choice be 
neceffary, or can be of any benefit, in deter- 
mining the ftate of the difeafe. 


It has been fuppofed hy fome, that inocu- 
lation has an advantage, by introducing a 
fmall portion only of the contagious matter : 
But this refts upon an uncertain foundation. 
It is not known what quantity is introduced 
by the common infeftion, and it may be a 
fmall quantity only. Although it were larg- 
er than that thrown in by inoculation, it is 
not afcertained that the circumftance of quan- 
tity would have any effeQ;. A certain quan- 
tity of ferment may be neceffary to excite fer- 
mentation in a given mafs ; but, that quantity 
givenj the fermentation and affimilation are 
<2xtended to the whole mafs ; and we do not 
find that a greater quantity than is juft necef- 
fary, either increafes the aflivity of the fer- 
mentation, or more certainly fecures the af- 
fimilation of the whole. In the cafe of the 
fmall pox, a confiderable difference in the 
quantity of contagious matter introduced, has 
not difcovered any e£fe£i ia modifying the 




Purging has the efFeft of diminifhing the 
a6livity of the fanguiferous fyftem, and of 
obviating its inflammatory flate. It is there- 
fore probable, that the frequent ufe of cool- 
ing purgatives is a praftice attending inocula- 
tion which may be of confiderable advantage ; 
and, probably, it is alfo ufeful by diminifhing 
the determination to the flcin. It appears to 
me, that mercurials and antimonials, as they 
are commonly managed, are ufeful only as 
ihey make a part of the purging courfe. 


It is probable, that the flate of the fmall 
pox depends very much upon the ftate of the 
eruptive fever, and particularly upon mode- 
rating the inflammatory fl;ate of the fkin ; and, 
therefore, it is probable, that the meafures 
taken for moderating the eruptive fever and 
inflammatory flate of the fkin, afford the 
greatefl improvement which has been made in 
the pra6lice of inoculation. The tendency of 
purging, and the ufe of acids, for this pur- 
pofe, is fufficiently obvious ; and upon the 
fame grounds, we fhould fuppofe that blood- 
letting might be ufeful ; but probably this has 
been omitted, for the fame reafon that perhaps 
might have led to the omiffion of other reme- 
dies alfo ; which is, that WQ have found a 



more powerful and effeftual one in the appli- 
cation of cold air, and the ufe of cold drink. 
Whatever doubts or difficulties our theory 
might prefent to us on this fubjeft, they may 
be entirely neglefled, as the praftice of In- 
doftan had long ago, and the pra6lice of this 
country has lately, by a large and repeated ex- 
perience, afcertained the fafety and efficacy of 
this remedy ; and as it may and can be more 
certainly employed with the praftice of inoc- 
ulation, than it can be in cafes of common in- 
fe6lion, it mufl give a fingular advantage to 
the former. 


After the eruption, when a few pimples 
only have appeared on the face, the continuincr 
the application of cold air, and the employ- 
ment of purgatives, has indeed been the prac-. 
tice of many inoculators ; but, I think, thefe 
praftices cannot be faid to give any peculiar 
advantages to inoculation ; for when the ftate 
of the eruption is determined, when the num- 
ber of puftules is very fmall, and the fever has 
entirely ceafed, I hold the fafety of the difeafe 
to be abfolutely afcertained, and the further 
ufe of remedies entirely fuperfluous. In fuch 
cafes, I judge the ufe of purgatives to be not 
only unnecelTary, but that they may be often 


' OF PHYSIC. 37 


I have thus confidered the feveral circum^ 
llances and pra£lices accompanying inocula- 
tion, and have endeavoured to afcertain the 
utility and importance of each. Upon the 
whole, I hope I have fufficiently afcertained 
the general utility and great advantage of this 
praftice, efpecially confifting in this, that if 
certain precautions, preparations, and reme- 
dies, are of importance, all of them can be 
employed with more certainty in the pra£lice 
of inoculation than in the cafe of common 

It remains now that I fhould offer fome re- 
marks on the condu6t of the fmall pox, as re- 
ceived by infe6tion, or even when, after in- 
oculation, the fymptoms fhall prove violent. 
The latter fometimes happens, although ev- 
ery precaution and remedy have been em- 
ployed. The caufe of this is not well known ; 
but it appears to me to be commonly owing 
to a difpolition of the fluids to putrefcency. 
But, however this may be, it v/ill appear, that, 
not only in the cafe of common infection, but 
even in that of inoculation, there may be oc- 
cafion for ftudying the conduft of this difeafe, 
in all its pofTible varying circumftances. 



When, from the prevailing of fmall pox as 

an epidemic, and more efpecially when it is 

Vol. II. C known 


known that a perfon not formerly atfeQed 
with the difeafe has been expofed to the in- 
feaion, if fuch perfon ihould be feized with 
the fymptoms of fever, there can be little 
doubt of its being an attack of the fmall pox ; 
and therefore he is to be treated in every re- 
fpeft as if the difeafe had been received by in- 
oculation. He is to be freely expofed to a 
cool air, to be purged, and to have cooling 
acids given liberally. 


If thefe meafures moderate the fever, noth- 
ing more is neceffary : But if the nature of 
the fever attacking a perfon be uncertain ; or, 
if, with fufpicions of the fmall pox, the fymp- 
toms of the fever be violent ; or even if, 
knowing the difeafe to be fmall pox, the meaf- 
ures mentioned DXCVII, fhail not mode- 
rate the fever fufficiently ; it will be proper 
to let fome blood ; and this will be more ef- 
pecially proper, if the perfon be an adult, of 
a plethoric habit, and accuflomed to full liv- 


In the fame circumflances, we judge it will 
be always proper to give a vomit, as ufeful in 
the commencement of all fevers, and more 
efpecially in this, where a determination to 



the flomach appears from pain and fponta- 
neous vomiting. 


It frequently happens, efpecially in infants, 
that, during the eruptive fever of the fmall 
pox, convulfions occur. Of thefe, if only- 
one or two fits appear on the evening preced- 
ing the eruption, they give a favourable prog- 
noflic of a mild difeafe, and require no reme- 
dy ; but if they occur more early, and be vio- 
lent and frequently repeated, they are very 
dangerous, and require a fpeedy remedy. 
For this purpofe, bleeding is hardly ever of 
fervice ; bliftering always comes too late ; and 
the only remedy I have found effectual is an 
opiate given in a large dofe. 


Thefe are the remedies necefTary during the 
eruptive fever ; and if, upon the eruption, the 
pimples upon the face be very few and dif- 
tinft, the difeafe is no further of any danger, 
requires no remedies, and the purgatives, 
which, as has been faid before, are by fomc 
pra6litioners continued, prove often hurtful. 

But when, upon the eruption, the pimples 

on the face are very numerous ; when they 

are not diftinft ; and efpecially, when upon 

the fifth day, the fever does not fuffer a con- 

C 2 hderable 


fiderable remiffion ; the difeafe will flill re- 
quire a great deal of attention. 


If, after the eruption, the fever fhall con- 
tinue, the avoiding heat, and the continuing 
to expofe the body to a cool air, will ftill be 
proper. If the fever be confiderable, with a 
full and hard pulfe, in an adult perfon, a 
bleeding will be neceffary ; and, more certain- 
ly, a cooling purgative. It is, however, fel- 
dom that a repetition of the bleeding will be 
pj-oper, as a lofs of ftrength does ufually come 
on very foon ; but the repetition of a purga- 
tive, or the frequent ufe of laxative glyfters, 
is commoHly ufeful. 


When a lofs of ftrength, with other marks 
of a putrefcent tendency of the fluids appears, 
it will be neceffary to exhibit the Peruvian 
bark in fubftance, and in large quantity. In 
the fame cafe, the free ufe of acids, and of ni- 
tre, is ufeful ; and it is commonly proper al- 
fo to give wine very freely. 


From the fifth day of the difeafe, onward 
through the whole courfe of it, it is proper to 
give an opiate once or twice a day ; taking 



care, at the fame time, to obviate coflivenefs 
by purgatives or laxative glyfters. 


In a violent difeafe, from the eighth to the 
eleventh day, it is proper to lay on bliflers 
fucceffively on different parts of the body, and 
that without regard to the parts being covered 
with puflules. 


If, in this difeafe, the tumour of the fauces 
be conliderable ; the deglutition difficult ; the 
faliva and mucus vifcid, and with difficulty 
thrown out ; it will be proper to apply blif- 
ters to the external fauces, and to employ dil- 
igently detergent gargles. 


During the whole courfe of the difeafe, 
when any conliderable fever is prefent, the 
frequent exhibition of antimonial medicines, 
in naufeating dofes, has been found ufeful ; 
and thefe,forthemoft part, fufficiently anfwer 
the purpofe of purgatives. 




The remedies mentioned from DCXXII, 
to DC XXVI, are thofe frequently neceffary, 
from the fifth day till the fuppuration is fin- 
idied. But as, after that period, the fever is 
fometimes continued and increafed ; or, as 
fometimes, when, after there has been little 
or no fever before, a fever now arifes, and 
continues with conftderable danger j this is 
what is called the Secondary Fever, and re- 
quires particular treatment. 


When the fecondary fever follows the dif- 
tin6l fmall pox, and the pulfe is full and hard, 
the cafe is to be treated as an inflammatory af- 
feftion, by bleeding and purging. But, if the 
fecondary fever follow the confluent fmall 
pox, and be a continuance or exacerbation of 
the fever which had fubfifted before, it is to 
be confidered as of the putrid kind j and in 
that cafe, bleeding is improper. Some purg- 
ing may be neceffary ; but the remedies to be 
chiefly depended on, are the Peruvian bark 
and acids. 

When the fecondary fever fir ft appears, 
whether it is after a diftinft or a confluent 
fmall pox, it will be ufeful to exhibit an anti- 
monial emetic in naufeating dofes, but in fuch 
manner as to produce fome vomiting. 




For avoiding the pits which frequently fol- 
low the fmall pox, many different meafures 
have been propofed ; but none of them appear 
to be fufficiently certain. 

C 4 CHAP. 





1 HIS difeafe feems to de- 
pend upon a fpecific contagion, and to affeft 
perfons but once in their lives. It is hardly 
ever attended with any danger ; but as it feems 
frequently to have given occafion to the fup- 
pofition of a perfon's having the fmall pox 
twice, it is proper to ftudy this difeafe, and to 
dillinguifh it from the genuine fmall pox. 


' This may be generally done by attending 
to the following circumllances. 

The eruption of the chicken pox comes on 
with very little fever preceding it, or with fe- 
ver of no determined duration. 



The pimples of the chicken pox, more quick- 
ly than thofe of the fmall pox, are formed into 
little velicles orpuflules. 

The matter in thefe puflules remains fluid, 
and never acquires the colour or confidence 
of the pus which appears in the puftules of the 
fmall pox. 

The puftules of the chicken pox are always 
in thre^^ or four days from their firft appear- 
ance, formed into crufts. 

See Dr. Heberden in Med. Tranfa^t. Vol,. 
I. art, xvii. 

Vol. 2. C 5 CHAP, 





1 HIS difeafe alfo depends 
upon a fpecific contagion, and aflFe6ls perfons 
but once in their lives. 


It occurs mod frequently in children ; but 
no age is exempted from it, if the perfons 
have not been fubjefted to it before. 


It commonly appears as an epidemic, firft 
in the month of January, and ceafes foon af- 
ter the fummer folftice ; but various acci- 
dents, introducing the contagion may produce 
the difeafe at other times of the year. 




The difeafe always begins with a cold ftagCj, 
which is foon followed by a hot, with the or- 
dinary fymptoms of thirft, heat, anorexia, 
anxiety, ficknefs, and vomiting ; and thele 
are more or lefs confiderable in different 
cafes. Sometimes from the beginning, the 
fever is fharp and violent ; often, for the firfl 
two days, it is obfcure and inconfiderable, but 
always becomes violent before the eruption, 
which ufually happens upon the fourth day. 


This eruptive fever, from its commence- 
ment, is always attended with hoarfenefs, with 
a frequent hoarfe dry cough, and frequently 
with fome difficulty of breathing. At the 
fame time, the eye lids are fomewhat fwelled^, 
the eyes are a little inflamed, and pour out 
tears ; and, together with thefe fymptoms, 
there is a coryza, and frequent fneezing. 
For the moil part, a conflant drowfinefs at- 
tends the beginning of this difeafe. 


The eruption, as we have faid, commonly^ 

appears upon the fourth day ; firfl on the 

face, and fucceflively on the lower parts of the 

body. It difcovers itfelf firil in fmall red- 

C 6 points ; 


points ; but, foon after, a number of thefe ap- 
pear in clufters, which do not arife into vifible 
pimples, but by the touch are found to be a 
little prominent. This is the cafe on the face ; 
but on other parts of the body, the promi- 
nence, or roughnefs, is hardly to be perceived. 
On the face the eruption retains its rednefs, 
or has that increafed for two days ; but, on 
the third, the vivid rednefs is changed to a 
brownifh red ; and, in a day or two more, 
the eruption entirely difappears, while a 
meally defquamation takes place. During 
the whole time of the eruption, the face is 
fomewhat turgid, but feldom confiderably 


Sometimes, after the eruption has appear- 
ed, the fever ceafes entirely ; but this is fel- 
dom the cafe ; and more commonly the fever 
continues, or is increafed after the eruption, 
and does not ceafe till after the defquama- 
tion. Eve^ then the fever does not always 
ceafe, but continues with various duration 
'and efFe6l. 


Though the fever happen to ceafe upon 
the eruption's taking place', it is common for 
the cough to continue till after the defquama- 
tion, and fome times much iono-er 




In all cafes, while the fever continues, the 
cough alfo continues, generally with an in- 
creafe of the difficulty of breathing ; and both 
of thefe fymptoms fometimes arife to a degree 
that denotes a pneumonic afFeftion. This 
may arife at any period of the difeafe ; but 
very often it does not come on till after the 
defquamation of the eruption. 

After the fame period, alfo, a diarrhoea 
frequently comes on, and continues for fome 


It is common for the meafles, even when 
they have not been of a violent kind, to be 
fucceeded by inflammatory afFe6lions, partic- 
ularly ophthalmia and phthifis. 


If the blood be drawn from a vein during 
the meafles, with the circumftances neceffary 
to favour the feparation of the gluten, this al- 
ways appears feparated, and lying on the fur- 
face of the: craflamentum, as in inflammatory 


For the moft part the meafles, even when 
violent, are without any putrid tendency ; but 
in fome cafes fuch a tendency appears, both 



in the courfe of the difeafe, and efpecially af, 
ter the ordinary courfe of it is finifhed. See 
Dr. Watfon, in London Med. Obfervations, 
Vol. IV. art. xi. 


From what is delivered (from D C X X XV 1 1, 
to DCXLII) it will appear, that the meafles 
are diflinguiftied by a catarrhal aflPeftion, and 
by an inflammatory diathefis to a confidera- 
ble degree ; and therefore the danger attend- 
ing them arifes chiefly from the coming on 
of a pneumonic inflammation, 


From this confideration it will be obvious, 
that the remedies efpecially neceflary are thofe 
which may obviate and diminiCh the inflam- 
matory diathefis ; and therefore, in a particu- 
lar manner, bloodletting. This remedy may 
be employed at any time in the courfe of the 
difeafe, or after its ordinary couife is finifhed. 
It is to be employed more or lefs according 
to the urgency of the fymptoms of fever, 
cough, and dyfpnoea ; and generally may be 
employed very freely. But, as the fymptoms 
of pneumonic inflammation feldom come on 
during the eruptive fever ; and as this fever 
is fometimes violent immediately before the 
eruption, though a fufficiently mild difeafe be 
to follow ; fo bleeding is feldom very neceffa- 


O F P H Y S I C. 51 

Ty during the eruptive fever, and may often 
be referved for the periods of greater danger 
which are perhaps to enfue. 


In all cafes of meafles, where there are no 
marks of putrefcency, and where there is no 
reafon, from the known nature of the epidem- 
ic, to apprehend putrefcency, bleeding is the 
remedy to be depended upon ; but affiftance 
may alfo be obtained from cooling purgatives ; 
and particularly from bliftering on the (ides^ 
or between the fhoulders. 


The dry cough may be alleviated by the 
large ufe of demulcent peflorals, mucilagin- 
ous, oily, or fweet. It may, however, be ob- 
ferved, with refpeft to thefe demulcents, that' 
they are not fo powerful in involving and 
corre6ling the acrimony of the mafs of blood 
as has been imagined ; and that their chief 
operation is by befmearing the fauces, and 
thereby defending them from the irritation of 
acrids, either arifing from the lungs or diftill- 
ing from the head. 


For moderating and quieting the cough in 
this difeafe, opiates certainly prove the moft 



eflFeftual means, whenever they can be fafely 
employed. In the meafles, in which an in- 
flammatory flate prevails*^ in a confiderable 
degree, opiates may be fuppofed to be inad- 
milhble ; and, in thofe cafes in which a high 
degree of pyrexia and dyfpnoea ihow either 
the prefence, or at leafl the danger, of pneu- 
monic inflammation, I think that opiates might 
be very hurtful. In cafes, however, in which 
the dyfpncea is not confiderable, and where 
bleeding, to obviate or abate the inflammatory 
fkte, has been duly employed, and where the 
cough and watchfulnefs are the urgent fymp- 
toms, I think that opiates may be fafely ex- 
hibited, and with great advantage. I think, 
further, that, in all the exanthemata, there 
is an acrimony diff^ufed over the fyfl:em, 
which gives a confiderable irritation ; and, for 
obviating the eff"e6ls of this, opiates are ufeful, 
and always proper, when no; particular con- 
traindication prevails. 


When the defquamation of the meafles is 
finiflied, though there fliould then be' no dif- 
order remaining, phyficians have thought it 
neceflary to purge the patient feveral times, 
with a view to draw off^ the dregs of this dif- 
eafe, that is, a portion of the morbific matter 
which is fuppofed to remain long in the body. 
I cannot reject this fuppofition ; but, at the 
fame time, cannot believe, that the remains of 



the morbific matter, difFufed over the whole 
mafs of blood, can be entirely drawn ofF b^ji 
purging ; and it appears to me, that to avoid 
the confequences of the meafles, it is not the 
drawing off the morbific matter which we need 
to lludy, fo much as the obviating and re- 
moving the inflammatory flate of the fyftem 
which had been induced by the difeafe. With 
this lafl view, indeed, purging may flill be a 
proper remedy ; but bleeding, in proportion 
to the fymptoms of inflammatory difpofition, 
is yet more fo. 


From our late experience of the benefit of 
cold air in the eruptive fever of the fmall pox, 
fome phyficians have been of opinion, that 
the pra6lice might be transferred to the mea- 
fles ; but we have not yet had trials fufiicient 
to afcertain this. There is no doubt that ex- 
ternal heat may be very hurtful in the mea- 
fles, as in mofl; other inflammatory difeafes ; 
and therefore the body ought to be kept in a 
moderate temperature during the whole courfe 
of the meafles ; but how far, at any period of 
the difeafe, cold air may be applied with fafe- 
ty, we are yet uncertain. Analogy, though 
fo often the refource of phyficians, is, in gen- 
eral, fallacious ; and further, though the an- 
alogy with the fmall pox might lead to the 
application of cold air during the eruptive fe- 
ver of the meafles, the analogy with catarrh 



feems to be againft the pra£lice. After the 
eruption had appeared upon the fkin, we have 
Iiad many inftances of cold air making it difap- 
pear, and thereby producing much diforderin 
the fyftem ; and have alfo had frequent ex- 
amples of fuch diforder being removed by re- 
floring the heat of the body, and thereby a- 
gain bringing forth the eruption. 






It may be doubted if the 
fcarlet fever be a difeafe fpecifically different 
from the Cynanche Maligna above defcribed. 
The latter is almoft always attended with a 
fcarlet eruption ; and, in all the inftances I 
have feen of what may be called the Scarlet 
Fever, the difeafe, in almoft every perfon af- 
fefted, has been attended with an ulcerous 
fore throat. 


This view of the matter may create fome 
doubt ; but I am ftill of opinion, that there is 
a fcarlet fever which is a difeafe fpecifically 
different from the Cynanche Maligna. 

Do£lor Sydenham has defcribed a fcarlet 
fever, wliich he had feen prevailing as an ep- 



idemic, with all the circumftances of the fever 
and eruption, without its being accompanied 
with any aflFe6lion of the throat ; at leaft he 
does not take notice of any fuch affeftion, 
which fuch an accurate obferver could not fail 
to have done, if any fuch fymptom, as we have 
commonly feen making a principal part of the 
difeafe, had attended thofe cafes which he had 
obferved. Several other writers have defcrib- 
ed the fcarlet fever in the fame manner, and 
I know phyficians who have feen the difeafe 
in that form ; fo that there can be no doubt of 
there being a fcarlet fever not neceffarily con- 
nefted with an ulcerous fore throat, and there- 
fore a difeafe different from the Cynanchc 


But, further, although in all the inftances 
of fcarlet fever which I have feen, (and in the 
courfe of forty years I have feen it fix or feven 
times prevailing as an epidemic in Scotland), 
the difeafe, in almoft all the perfons affe6l- 
ed, was attended with an ulcerous fore throat, 
or was what Sauvages names the Scarlatina 
Anginofa ; and although, in fome inftances the 
ulcers of the throat were of a putrid and 
gangrenous kind, and at the fame time the dif- 
eafe in all its fymptoms refembled very exaft- 
ly the cynanche maligna ; yet I am ftill per- 
fuaded, that not only the Scarlatina of Sy- 
denham, but that even the Scarlatina Angino- 


O F P H Y S I c. ^^ 

fa of Sauvages, is a different difeafe from the 
Cynanche Maligna ; and I have formed this 
opinion from the following confiderations, 


i/, Th^re is a fcarlet fever entirely free 
from*any affeftion of the throat, which fome- 
times prevails as an epidemic ; and therefore 
there is a fpecific contagion producing a icar- 
let eruption without any determination to the 

lily^ The Scarlatina, which, from its matter 
being generally, determined to the throat, m^y 
be properly termed Anginofa, has, in many 
cafes of the fame epidemic, been without any 
atfeflion of the throat ; and therefore the con- 
tagion may be fuppofed to be more efpecially 
determined to produce the eruption only. 

3^/);, Though in all the epidemics that I 
could allege to be thofe of the Scarlatina An- 
ginofa, there have been fome cafes, which, in 
the nature of the ulcers, and in other circum- 
llances, exaftly refembled the cafes of the 
Cynanche Maligna ; yet I have as conftantly 
remarked, that thefe cafes have not been a- 
bove one or two in a hundred, while the reft 
have all of them been with ulcers of a benign 
kind, and with circumftances hereafter to be 
defcribed, fomewhat diflFerent from thofe of 
the Cynanche Maligna. 

\thly. On the other hand, as I have two or 
three times feen the Cynanche Maligna epi- 


demically prevailing ; fo, among the perfons 
afFe6led, I have feen inftances of cafes as mild 
as thofe of the Scarlatina Anginofa ufually 
are ; but here the proportion was reverfed ; and 
thefe mild cafes were not one fifth of the whole, 
while the reft were of the putrid and malignant 

Lajlly, It applies to the fame purpofe to 
obferve, that of the Cynanche Maligna, moft 
of the inftances terminate fatally ; while, on 
the other hand, that is the event of very few 
of the cafes of the Scarlatina Anginofa. 


From thefe confiderations, though it may 
appear that there is fome affinity between the 
Cynanche Maligna and Scarlatina Anginofa, 
it will ftill remain probable that the two dif- 
eafes are fpecifically different. I have been 
at fome pains to eftablifli this opinion ; for, 
from all my experience, I find, that thofe two 
difeafes require a different treatment ; and I 
therefore now proceed to mention more par- 
ticularly the circumftances of the Scarlatina 


This difeafe commonly appears about the 
beginning of winter, and continues through- 
out that feafon. It comes on with fome cold 
ftiivering, and other fymptoms of the fever 



which ufually introduces the other exanthe- 
rruita. But here there is no cough, nor the other 
catarrhal iymptoms which attend the meafles; 
nor is there that anxiety and vomiting which 
commonly introduce the confluent fmall pox, 
and which more certainly introduce the Cy- 
nanche Maligna. 

Early in the difeafe fome uneafinefs is felt 
in the throat ; and frequently the deglutition is 
difficult, generally more fo than in the Cy- 
nanche Maligna. Upon looking into the fau- 
ces, a rednefs and fwelling appear, in colour 
and bulk approaching to the ftate of thefe 
fymptoms in the Cynanche Tonfillaris ; but 
in the Scarlatina, there is always more or lefs 
of floughs, which feldom appear in the Cy- 
nanche Tonfillaris ; and the floughs are com- 
monly whiter than thofe in the Cynanche 

While thefe appearances are difcovered in 
the fauces, upon the third or fourth day a 
fcarlet eruption appears on the flcin, in the 
fame form as defcribed in (CCCXIV.) This 
eruption is commonly more conliderable and 
univerfal than in the Cynanche ; but it fel- 
dom produces a remiflion of the fever. The 
eruption for the mofl part remains tiU the 
third or fourth day after its flrfl; appearance ; 
but then goes ofl^, ending in a meally def- 
quamatiofi. At this time the fever ufually 
fubfides ; and, generally, at the fame time, 
Ibme degree of fweat comes on. 



The floughs, on the fauces, which appeared 
early in the difeafe, continue for fome days ,- 
but then falling off, difcover the fwelling a. 
bated, and an ulcer formed on one or both 
tonfils fhowing a laudable pus ; and foon af- 
ter the fever has fubfided, thefe ulcers heal 
up entirely. For the mofl part this difeafe 
has much lefs of coryza attending it than the 
Cynanche Maligna ; and, when there is a co- 
ryza attending the Scarlatina, the matter dif- 
charged is lefs acrid, and has not the fetid 
fmell which it has in the other difeafe. 

In the Scarlatina, when the eruption has 
entirely difappeared, it frequently happens, 
that, in a few days after, the whole body is af- 
fefted with an anafarcous fwelling ; which, 
however, in a few days more, gradually fub- 

We have thus defcribed the moft common 
circumftances of the Scarlatina Anginofa ; 
and have only to add, that, during the time of 
its being epidemic, and efpecially upon its 
firfl fetting in, there are always a few cafes in 
which the circumftances of the difeafe ap- 
proach very nearly to thofe of the Cynanche 
Maligna ; and it is only in thefe inftances that 
the difeafe is attended with any danger. 


With refpeft to the cure of this difeafe, 
when the fymptoms of it are nearly the fame 
with thofe of the Cvnanche , Maliijna, it 


O F P H Y S I C. 61 

requires exaftly the fame treatment as dire6led 


When the fcarlet fever appears without any 
afFeftion of the throat, the treatment of it is 
very fimple, and is delivered by Dr. Syden- 
ham. An antiphlogiftic regimen is common- 
ly all that is requifite ; avoiding, on one hand, 
the application of cold air ; and, on the other' 
any increafe of external heat. 


In the ordinary flate of the Scarlatina An- 
ginofa, the fame treatment is, in moll cafes, 
fufFicient ; but as here the fever is commonly 
more confiderable, and there is likewife an af- 
feaion of the throat, fome remedies may be 
often neceflary. 


When there is a pretty high degree of fe- 
ver, with a full pulfe, and a confiderable 
fwellmg of the tonfils, bleeding is very prop- 
er, efpecially in adults ; and it has been fre- 
quently p^aifed with advantage j bat as, 
even in the Cynanche Tonfillaris, much 
bleedmg is feldom neceffary, (CCCV) j fo, in. 
the Scarlatina, wjien the (late of the fever and 
the appearances of the fauces render the na- 

Vol. ir. D ture 


tiire of the difeafe ambiguous, bleeding may 
be omitted j and, if not altogether avoided, it 
fhould at lead not be large, and ought not to 
be repeated. 


Vomiting, and efpecially naufeating dofcs 
of emetics, notwithftanding the inflamed (late 
of the fauces, have been found very ufefiil 
in this difeafe. An open belly is proper in 
every form of this difeafe ; and when the 
il^feating dofes of emetics operate a little 
downwards, they are more ferviceable. 


In every form of the Scarlatina Anginofa, 
through the whole courfe of it, detergent gar- 
gles fhould be employed, and more or lefs as 
the quantity of Houghs and the vifcid mucus 
in the fauces may feem to require. 


Even in the milder ftates of the Scarlatina 
Anginofa, it has been common with pradi- 
tioners to exhibit the Peruvian bark through 
the whole courfe of the difeafe ; but we are 
affmed, by much experience, that in fuch cafes 
it may be fafely omitted, though in cafes any 
v/ays ambiguous it may not be prudent to 
negleft this remedy. * 




The anafarcous fwelling, which frequently 
follows the Scarlatina Anginofa, feldom re- 
quires any remedy ; and, at leaft, the purga- 
tives fo much inculcated, and fo commonly 
exhibited, foon take off the anafarca. 








of the Phenomena of the Plague, 

1 HE Plague is a difeafe 
which always arifes from contagion ; which 
affefts many perfons about the fame time ; 
proves fatal to great numbers ; generally pro- 
duces fever ; and, in moll perfons, is attended 
with buboes or carbuncles. 


Thefe are the circumftances which, taken 
together, give the chara6ler of the difeafe ; 



but it is accompanied with rtiany fymptoms 
almoft peculiar to itfelf, that in different per- 
fons are greatly divcrfified in number and de- 
g^ree, and fhould be particularly ftudied. I 
would wifh to lay a foundation for this j but 
think it unfit for a perfon who has never feen 
the difeafe to attempt its particular hiflory. 
For this, therefore, I muft refer to the au- 
thors who have written on the fubjed ; but 
allowing thofe only to be confulted, who have 
themfelves feen and treated the difeafe in all 
its different forms. 


From the accounts of fuch authors, it ap- 
pears to me, that the circumftances which par- 
tictilarly diftinguifh this difeafe, and efpeciaily 
fhe moire violent and dangerous ftates of it, 

i/. The great lofs of ftrength in the ani- 
mal functions, which often appears early in 
the difeafe. 

zdly, The ftupor, giddinefs, and confequene 
ftaggering, which refemblcs dninkennefs, or 
the hea.iach, and various delirium ; which are 
all of them fymptoms denoting a great difor- 
der in the funftions of the brain. 

3^/)«i The anxi^ety, palpitation, fvncope, 
and^elpecially the weaknefs and irregularity 
f>f the pulfe, wHich denote a eonlidcrable difl 
turban-ce in the aftion of the heart. 

O 3 iihlv. The 


4thiy, The naufea and vomiting, particu- 
larly the vomiting of bile, which fhows an ac- 
cumulation of vitmtcd bile in the gall bladder 
and biliary duds, and from thence derived 
into the inteftines and ftomach ; all of which 
fymptoms I fuppofe to denote a confiderable 
fpafm, and lofs of tone, in the extreme veffels 
on the furface of the body. 

5M/)', The buboes or carbuncles, which 
denote an acrimony prevailing in the 
fluids. And, 

Lajlly, The petechiae, hemorrhagies, and 
colliquative diarrhoea, which denote a putref- 
cent tendency prevailing to a great degree in 
the mafs of blood. 


From the confideration of all thefe fymp- 
toms, it appears, that the plague is efpecially 
diflinguilhed by a fpecific contagion, often 
fuddenly producing the moft confiderable 
fymptoms of debility in the nervous fyflem 
or moving powers, as well as of a general pu- 
trefcency in the fluids ; and it is from the con- 
fideration of thefe circumftances as the prox- 
imate caufe, that I think both the prevention 
and cure of the plague mull be direfted. 


If this difeafe fhould revifit the northern 
parts of Europe, it is probable, that, at the 


O F P H Y S I C. ^7 

time, there will be no phyfician then alive, 
who, at the firfl appearance of the difeafe, 
can be guided by his former experience, but 
muft be inftrufted by his ftudy of the writers 
on this fubjeft, and by analogy. It is, there- 
fore, I hope, allowable for me, upon the lame 
grounds, to offer here my opinion with refpeft 
to both the prevention and cure of this dii- 

This paragraph was written before I had 
any notice of the plague of Mofcow anno 
1771 ; but I think it will flill apply to the 
cafe of Greatbritain and of many other north- 
ern ftates. 



Oj the Prevention of the Plague. 


WITH refpeft to the prevention : As wc 
are firmly perfuaded that the difeafe never a- 
rifes in the northern parts of Europe, but in 
confequence of its being imported from fome 
other country; fo the firfl meafure neceffary, 
is the magiflrate's taking care to prevent the 
importation ; and this may generally be done 
by a due attention to, bills of health, and to 
the proper fJerformance of quarantines. 




With rerpecl to the latter, we are perfuad- 
ed, that the quarantine of perfons may fafel}' 
be much lefs than forty days ; a.nd, if this were 
allowed, the execution of the quarantine would 
be more cxaft and certain, as the temptation 
to break it would be in a great meafure re- 


With refpefl to the quarantine of goods ; 
it cannot be perfeft, unlefs the fufpefted 
goods be unpacked and duly ventilated, as 
well as the other means employed for cor- 
recting the infe6lion they may carry ; and, if 
all this were properly done, it is probable that 
the time commonly prefcribed for the quar- 
antine of goods might alfo be fliortened. 


A fecond meafure, in the way of preven- 
tion, becomes requifite, when an infeftionhas 
reached and prevailed in any place, to pre- 
vent that infe«^;ion from fpreading into other 
places. This can be done only by preventing 
the inhabitants, or the goods, of any infected 
place, from going out of it, till they have un- 
dergone ^ proper quarantiiite. 


OF P ir Y S I C. 69 


The third meafure for prevenCion, to be 
employed with great care, is to hindet the 
iiiTe^iion from fpreading among the inhab- 
itants of the place in which it has arifen. 
The meafures necellciry for this, are to be di- 
refted by the do6trine laid down in L X X X 1 1 ; 
and from that doclrine we infer, that all per- 
fcms who can avoid any near communication 
with infefted perfons, or goods, may elcape 
the infeftion^ 


For avoiding fuch communication, a great 
deal may be done by the magi Urate ; 1. By 
allowing as many of the inhabitants as are free 
from the infe6lion, and not necefTary to the 
fervice of the place, to go out of it. 2. By 
prohibiting all aifemblies, or unneceffary in- 
tercourfe, of the people. 3. By taking care 
that neceflary communications be performed 
without contaft. 4. By making fuch ar- 
rangements and provifions as may render it 
eafy for the families remaining to fliut them- 
felves up in their own houfes. 5. By allow- 
ing perions to quit houfes in which an infec- 
tion appears, upon condition that they go in- 
to lazarettoes. 6. By ventilating*nd purify- 
ing, or deftroying at the public expenfe, all 
infefted goods. LaRlv, By avoiding hofpi-^ 

Vol. 2, D 5, tals^ 


tals, and providing feparate apartments for in- 
fefted perfons. 

The execution of thefe meafures will re- 
(]fuire great authority, and much vigilance and 
attention, on the part of the magitlrate ; but 
it is not our province to enter into any detail 
on this fubjed of the public police. 


rhe fourth and laft part of the bufinefs of 
prevention, refpefts the conduft of perfons 
neccflarily remaining in infe6led places, ef- 
pecially^of thofe obliged to have fome com- 
munication with perfons infefted. 


Of thofe obliged to remain in infefted 
places, but not obliged to have any near com- 
munication with the fick, they may be preferv- 
ed from the contagion by avoiding all near 
communication with other perfons, or their 
goods ; and, it is probable, that a fmall dif- 
tance will anfwer the purpofe, if, at the fame 
time, there be no flream of air to carry the 
cifluviA of perfons, or goods, to fome diftance. 


For thofe who are neceffarily obliged to 
have a near cofnmunication with the fick it is 
proper to let them know, that fome of the moil 



powerful contagions do not operate, but when 
the bodies of men expofed to the contagion 
are in certain circumflances which render 
them more Hable to be affeaed by it, or when 
certain caufes concur to excite the power of 
it ; and therefore, by avoiding thefe circum- 
flances and caufes, they may often efcape m- 


The bodies of men are efpecially liable to 
be affeaed by contagions, when they are any 
ways confiderably weakened by M^ant of food, 
and even by a fcanty diet, or one of little nour- 
ifhment ; by intemperance in drinking, which,, 
when the ftupor of intoxication is over, leaves 
the body in a weakened ftate ; by excefs in 
venery ; by great fatigue j or by any con- 
fiderable evacuation. 


The caufes which, concurring with conta- 
gion, render it more certainly aaive, are cold, 
fear, and full living. 

The feveral means, therefore, of avoiding 
or guarding againfl the aaion of cold (XCI V, 
to XCVI) are to be carefully ftudied. 


Againfl fear the mind is to be fortified as 

well as poffible, bv infpiring a favourable idea 

b 6 of 



of the power of prefervative means ; by de- 
fli-03'ing the opinion of the incurable nature 
of the difeafe ; by occupying mens' minds with 
bufmefs or labour ; and by avoiding all ob- 
jecls of fear, as funerals, paffing bells, and any 
notice of the death of particular friends. 


A full diet of animal food increafes the ir- 
ritability of the body, and favours the opera- 
lion of contagion ; and indigeftion, whether 
from the quantity or quality of food, has the 
ia:ne effeft. 


iiefides giving attention to obviate the fev- 
eral circumftances (DCX, DCLXXIX, to 
DCLXXXII) which favour the operation of 
contagion, it is probable thatfome means may 
be emplo}'ed for flrengthening the bodies of 
men, and thereby enabling them to rclifl con- 

For this purpofe, it is probable, that the 
moderate ufe of wine, or of fpirituous liquors, 
may have a good effeft. 

It is probable alfo, that exercife, when it 
ran be employed, if fo moderate as to be nei- 
ther heating nor fatiguing to the body, may 
be employed with advantage. 

Perfons who have tried cold bathing, and 
commonly feel invigorating efl[^6ls from it, if 




they are anywife fecure againfl having already 
received infeftion, may poffibly be enabled to 
refill it by the ufe of the cold bath. 

It is probable, that fome medicines alfo may 
be ul'eful in enabling men to refift infeftion ; 
but amongft thefe I can hardly admit the nu- 
merous alexipharmics formerly propofed ; or, 
at leaft, very few of them, and thofe only of 
tonic power. Amongft thefe laft we reckon 
the Peruvian bark ; and it is perhaps the moft 
effeftual. If any thing is to be expefted from 
antifeptics, I think camphire, whether inter- 
nally or externally employed, is one of the 
moft promifmg. 

Every perfon is to be indulged in the ufe 
of any means of prefervation of which he has 
conceived a good opinion, whether it be a 
charm or a medicine, if the latter be not di- 
redlly hurtful. 

Whether ilfuesbe ufeful in preferving from, 
or in moderating the effefts of, contagion, I 
cannot determine from the obfervations I have 
yet read. 


As neither the atmofphere in general, nor 
any confiderable portion of it, is tainted or 
impregnated with the matter of contagions ; 
fo the lighting of fires over a great part of the 
infe6led city, or other general fumigations in 
the open air, are of no ufe for preventing the 
difeafe, and may perhaps be hurtful. 





It would probably contribute much to 
check the progrefs of infeftion, if the poor were 
enjoined to make a frequent change of cloth- 
incy, and were fuitably provided for that pur- 
pofe ; and if they were, at the fame time, in- 
duced to make a frequent ventilation of their 
houfes and furniture. 

Sect. III. 
Of the Cure of the Flagve. 


IN the cure of the plague, the indications 
are the fame as thofe of fever in general 
(CXXVI) ; but here they are not all equally 
neceffary and important. 


The meafures for moderating'the violence 
of reaftion, which operate by diminifhingr the 
adion of the heart and arteries (CXXVIII), 
have feidom any place here, excepting fo far 
as the antiphlogiftic regimen is generally prop- 
er. Some phylicians, indeed, have recom- 


mended bleeding ; and there may occur cafes 
in which bleeding may be ufeful ; but, for the 
moft part, it is unnecelfary, and in many 
cafes it might be very hurtful. 

Purging has alfo been recommended ; and, 
in fome degree, it may be ufeful in drawing 
off the bile, or other putrefcent matters fre- 
quently prefent in the inteftines ; but a large 
evacuation this way may certainly be hurtful. 


The moderating the violence of readion, 
fo far as it can be done by taking off the 
fpafm of the extreme velfels (CLI), is a meaf- 
ure of the utmoll neceffity in the cure of the 
plague ; and the whole of the means (CLI I, 
to CC) fuited to this indication are extremely 


The giving an emetic at the very firft ap- 
proach of the difeafe, would probably be of 
great fervice ; and it is likely, that at fome 
other periods of the difeafe, emetics might be 
ufeful, both by evacuating bile abundant in 
the alimentary canal, and by taking off the 
fpafm of the extreme velfels. 


From fome principles with refpeft to fever 
in general, and with refpe6l to the plague in 



particular, I am of opinion,, that, after the ex- 
hibition of the firft vomit, the body Ihould be 
dilpofed' to fweat ; which ought to be raifed 
to a moderate degree onlj, but continued for 
at lead twenty four hours, or longer if the pa- 
ticnl; bear it eahly. 


This fweating fiiould be excited and coji- 
duded agreeably to the rules laid down in 
(CLXVIII.) It is to be promoted by the 
plentiful ufe of diluents, rendered more grate- 
ful by vegetable acids, or more powerful by 
being impregnated with fomje pgrtiion of neu- 
tral falts. 


To fupport the patient under the continu- 
ance of the fweat, a little weak broth, acidu- 
lated with juice of lemons, may be given fre- 
quendy ; and fometimes a little wine, if the 
heat of the body be not confiderable. 


If fudorific medicines are judged to be nec- 
effary, opiates are the moft effeflual and fafe ; 
but they lliould not be combined with aro- 
matics ; and probably may be more cfFetlual, 
if joined with a portion of emetics and oi 
neutral falts. 


OF PHYSIC. 'j'j 


If, notwithilanding the ufe of emetics and 
fudorifics, the difeafe fliould flill continue, 
the cure mufl depend upon the employment 
of means for obviating debility andputrefcen- 
cy ; and, for this purpofe, the various reme- 
dies proporedabove(fromCCI,toCCXXVn}, 
may all beadminiftered, but efpecially the ton- 
ics ; and of thofe the chief are cold drink and 
the Peruvian bark. 


In the cure of the plague, fome attention is 
due to the managemient of buboes and car- 
bu-ncles ; but w« do not touch this, as it be- 
longs to the province of furgery. 






In CCLXXIV I mentioned 
the diftin6lion which I propofed to make be- 
tween the difeafes to be named the Erythema 
and the Eryfipelas ; and from thence it will 
appear, that Eryfipelas, as an Erythema fol- 
lowing fever, may have its place here. 


I fuppofe the Eryfipelas to depend on a 
matter generated within the body, and which, 
analogous to the other cafes of exanthemata, 
is, in confequence of fever, thrown out upon 
the furface of the body. I own it may be dif- 
ficult to apply this to every particular cafe of 
eryfipelas ; but I take the cafe in which it is 
generally fuppofed to apply, that of the ery- 


fipelas of the face ; which I ftiall therefore 
confider here. 


The Ery fipelas of the face comes on with a 
cold fliivering, and other fymptoms of pyrex- 
ia The hot ftage of this is frequently attend- 
ed with a confufion of head, and fome de- 
gree of delirium ; and almoft always with 
drowfinefs, or perhaps coma. The pulfe is 
always frequent, and commonly full and hard, 


When thefe fymptoms have continued for 
one, two, or at moft three days, there appears, 
on fome part of the face, a rednefs, iuch as 
that defcribed in (CCLXXV) as the appear- 
ance of Erythema. This rednefs, at firll, is 
of no great extent ; but gradually fpreads 
from the part it firft occupied to the other 
parts of the face, commonly till it has afFeded 
the whole ; and frequently from the face it 
fpreads over the hairy fcalp, or defcends on 
fome part of the neck. As the rednefs 
fpreads, it commonly dilappears, or at leaft 
decreafes, in the parts it had before occupied. 
AH the parts upon which the rednefs appears 
are, at the fame time, affeaed with fome fwell- 
ing, which continues for fome time after the 
rednefs has abated. The whole face becomes 



confiderably turgid ; and the eyelids arc often 
fo much IVvelled, as entirely to fliut up the 



When the rednefs and fwclling have proceed- 
ed for fome time, there commonly arife, foon- 
er or later, b]iflers of a larger or fmaller fize, 
on feveral parts of the face. Thefe contain a 
thin yellov/ifh or almoll colourlefs liquor, 
which fooner or later runs out. The furface 
of the fkin, in the bliflered places, fometimes 
becomes livid and blackifh ; but this livor fel- 
dom goes deeper than the furface, or^difcovers 
any degree of gangrene afFefting the fkin. 
On the parts of the face not affe6ted with blif- 
ters, the cuticle fuffers, towards the end of the 
difeafe, a confiderable defquamation. 

Sometimes the tumour of the eyelids ends 
in a fuppuration. 


The inflammation coming upon the face 
does not produce any remifiion of the fever 
which had before prevailed ; and fometimes 
the fever increafes with the increafmg and 
fpreading inflammation. 




The inflammation ufually continues for 
eight or ten days ; and for the fame time, the 
fever and fymptoms attending it alfo con- 


In the progrefs of the inflammation the de- 
lirium and coma attending it fometimes go on 
increafmg, and the patient dies apopledic on 
the feventh, ninth, or eleventh day of the dif- 
eafe. In fuch cafes, it has been commonly 
fuppofed that the difeafe is tranflated from 
the external to the internal parts. But I have 
not feen any inftance in which it did not appear 
to me, that the afFeftion of the brain was 
merely a communication of the external af- 
feftion, as this continued increafmg at the 
fame time with the internal. 


When the fatal event does not take place, 
the inflammation, after having affeaed a part' 
commonly the whole of the face, and perhaps* 
the other external parts of the head, ceafes. 
With the inflammation, the fever alfo ceafes ; 
and, without any evident crifis, the patient 
returns to his ordinary ttate of health. 




This difeafe is not commonly contagious ; 
but as it may arife from an acrid matter ex- 
ternally applied, fo it is poffible that the dif. 
eale may fometimes be communicated from 
one perfon to another. 

Perfons who have once laboured under this 
difeafe are liable to returns of it. 


The event of this difeafe may be forefeen 
from the ftate of the fymptoms which denote 
more or lefs affeftion of the brain. If neither 
delirium nor coma come on, the difeafe is fcl- 
dom attended with any danger ; but when 
thefe fymptoms appear early in ' the difeafe, 
fr and are in a confiderable degree, the utmofl 
danger is to be apprehended. 


» As this difeafe often arifes in the part, at 
the fame time with the coming on of the py- 
rexia ; as I have known it, with all its fymp- 
toms, arife from an acrimony applied to the 
part ; as it is commonly attended with a full, 
and frequv-ntly a hard pulfe j as the blood 
drawn in this difeafe ftiOws the fame crufl upon 
its furface that appears in the phlegmafiae ; 
and, laftly, as the fwelling of the eyelids, in 



this difeafe, frequently ends in a fuppuration ; 
fo, from thefe confiderations, it feems doubt- 
ful if this difeale be properly, in Nofology, 
feparated from the Phlegmafiae. At any 
rate, I take the difeafe I have defcribed to be 
what phyficians have named the Erylipelas 
Phlegmonodes, and that it partakes a great 
deal of the nature of the Phlegmafiae. 


Upon this conclufion, the Eryfipelas of 
the face is to be cured very much in the fame 
mannef as phlegmonic inflammations, by 
bloodletting, cooling purgatives, and by em- 
ploying every part of the antiphlogiftic regi- 
men ; and our experience has confirmed the 
fitnefs of this method of cure. 


The evacuations of bloodletting and purg- 
ing are to be employed more or lefs according 
to the urgency of fymptoms, particularly thofe 
of the pyrexia, and of thofe which mark an 
affeclion of the brain. As the pyrexia con- 
tinues, and often increafes with the inflam- 
mation of the face ; fo the evacuations men- 
tioned may be employed at any time in the 
courfe of the difeafe. 




In this, as in other difeafes of the head, it 
is proper to put the patient, as often aS he 
ean ealily bear it, into fomewhat of an ereft 


As in this difeafe there is always an exter- 
nal affe6lion, and as in many inflances there 
is no other ; fo various external applications to 
the part afFeftedhave been propofed ; butal- 
moft all of them are of doubtfuF effeft. 
The narcotic, refrigerant, and aftringent 
applications, are fufpefted of difpofing to 
gangrene ; fpirituous applications feem to in- 
creaie the inflammation ; and all oily or watery 
applications feem to occafion its fpreading. 
The application that feems moll fafe, and 
which is now moft commonly employed, 
that of a dry mealy powder frequently fpr 
kled upon the inflamed parts. 




An Eryfipelas Phlegmonodes frequently 
appears on other parts of the body befide the 
face ; and fuch other eryfipelatous inflamma- 
tions frequently end in fuppuration. There 
cafes are feldom dangerous. At coming on, 
they are fometimes attended with drowfinefs, 



and even with fome delirium ; but this rarelv 
happens ; and thefe fymptoms do not continue 
after the inflammation is formed. I have never 
I'een an inftance of the tranflation of this in- 
flammation from the Hmbs to an internal part ; 
and though thele inflammations of the limbs 
be attended with pyrexia, they feldom require 
the fame evacuations as the erylipelas of the 
face. At firft; they are to be treated by dry 
mealy applications only ; and all humid ap- 
plications, as fomentations, or poultices, are 
not to be applied, till, by the continuance of 
the difeafe, by the increafe of fwelling, or by 
a throbbing felt in the part, it appears that the 
difeafe is proceeding to fuppuration. 


We have hitherto confidered eryfipelas as 
in a great meafure of a Phlegmonic nature ; 
and, agreeably to that opinion, "Vve have pro- 
pofed our method of cure. But it is probable, 
that an eryfipelas is fometimes attended wirh, 
or is a fymptom of, a putrid fever ; and, m 
fuch cafes, the evacuations propofcd abovd 
may be improper, and the ufe of the Peruvian 
bark may be neceflary ; but I cannot be ex- 
plicit upon i-his lubjeft, as fuch putrid cafes 
have not come under my obfervation. 

Vol. II. E CHAP. 




1 HIS difeafe is faid to have 
been unknown to the ancients, and that it ap- 
peared, for the firfl: time, in Saxony, about 
the middle of the laft century. It is faid to 
have fpread from thence into all the other parts 
of Europe; and, fmce the period mentioned, to 
have appeared ift many countries in which it 
had never appeared before. 


From the time of its having been firfl par- 
ticularly obferved, it has been defcribed and 
treated of by many different writers j and by 
all of them, till very lately, has been confid- 
ered as a peculiar idiopathic difeafe. 

It is faid to have been conflantly attended 
with peculiar fymptoms. It comes on with 
a cold flage, which is often confiderable. T5ie 
hot ftage which fucceeds, is attended with 



great anxiety, and frequent fighing. The 
heat of the body becomes great, and foon pro- 
duces profuCe fweating ; preceded, however, 
by a fenfe of pricking, as of pin points, in the 
fkin ; and the fweat is of a pecuharly rank and 
difagreeable odour. The emption appears 
fooner or later in different perfons, but at no 
determined period of the difeafe. It feldom 
or never appears on the face ; but difcovers 
itfelf firft upon the neck and breaft, and from 
thence often fpreads over the whole bodv. 


The eruption named Mihary is faid to bt 
of two kinds ; the one named the Red, the 
other the White Miliary. The former, which 
in Englifh is flriftly named a Rafh, is com- 
monly allowed to be afymptomatic afFeftion ; 
and as the latter is the only one that has any 
pretenfions to be confidered as an idiopathic 
difeafe, it is this alone that I fhali more par- 
ticularly defcribe and treat of in the prefent 


Wh?.t then is called the White Miliary 
eruption, appears at firfl like the red, in very 
fmall red pimples, for the moll part diftinft, 
but fomttimes cluftercd together. Their 
flight prominence is diftinguiihed better by 
the finger than by the eye. Soon after the 
E a appearance 


appearance of this eruption, and at leaft on 
the lecond day, a fmall veficJe appears upon 
the top of each pimple. At firfl the veficle 
IS whey coloured ; but foon becomes white 
and ftands out like a little globule on the top 
of the pimple. In two or three days, thefe 
globules break, or are rubbed off ; and are 
iucceeded by fmall crufts, which foon after 
fall off in fmall fcales. While one fet of pim- 
ples takes this courfe, another fet fucceeds ; fo 
that the difeafe often continues upon the Ikin 
for many days together. Sometimes when 
one crop of this eruption has difappeared, an- 
other, attcr fome interval, is produced. And 
It has been further obferved, that in fome per- 
fons there is fuch a tendency to this difeafe 
that they have been affeded with it feveral 
times m the courfe of their lives. 


This difeafe is faid to affed both fexes, and 
pcrfons of all ages and conflitutions ; but it 
has been obferved, at ajl times, to affed efpec- 
laily, and moft frequently, lying in women. 


This difeafe is often accompanied with vio- 
lent lymptoms, and has frequently proved fa- 
tal. The fymptoms attending it, are, howev- 
er,^ very various. They are, in one or other 
mitance, all tlie feveral fymptoms attending 


O F P H Y S I C. 89 

febrile difeafes ; but I cannot find that any 
lyinptom or concourfe of fymptoms are flead- 
ily the fame in different perfons, fo as to fur- 
nifh any fpecific charafter to the difeafe. 
When the difeafe is violent, the moft common 
fymptoms are phrenitic, comatofe, and con- 
vulfive affeftions, which are alfo fymptoms of 
all fevers treated by a very warm regimen. 


While there is fuch a variety of fymptoms 
appearing in this difeafe, it is not to be ex- 
pefted that any one particular method of cure 
can be propofed ; and accordingly we find, 
m different writers, different methods and 
remedies prefcribed ; frequent difputes about 
the moft proper ; and thofe received and 
praQifed by fome, oppofed and rejefted by 


I have thus given an account of what I have 
found delivered bv authors who have confid- 
ered the white miliary fever as an idiopathic 
difeafe ; but, now, after haA^ing often obferved 
the difeafe, I muft fay that 1 doubt much if 
it ever be fuch an idiopathic as has been fup- 
pofed ; and I fufpeft that there is much falla- 
cy in what has been written on the fubjeft. 





It feems to me very improbable, that this 
fhould have been really a new difeafe when it 
was firlt confidered as fuch. There appear 
to me very clear traces of it in authors who 
wrote long before that period ; and though 
there were not, we know that the defcriptions 
of the ancients were inaccurate and imperfed, 
particularly with refpeft to cutaneous affec- 
tions ; whilil we know alfo very well, that 
thofe affeftions which ufually appeared as 
fymptomatic only, were commonly negleded, 
or confounded together under a general ap- 


The antecedent fymptoras of anxiety, figh- 
ing, and pricking of the fkin, which have 
been fpoken of as peculiar to this difeafe, are, 
however, common to many others ; and, per- 
haps, to all thofe in which Iweatings are forced 
out by a warm regimen. 

Of the fymptoms faid to be concomitant of 
this eruption, there are none which can be faid 
to be conflant and peculiar but that of fweat- 
ing. This, indeed, always precedes and ac- 
companies the eruption ; and, while the mili- 
ary eruption attends many different difeafes, 
it never, however, appears in any of thefe, but 
after fweating ; and, in perfons labouring un- 

O F P H Y S I C. 91 

der thefe difeafes, it does not appear, if fweaU 
ing be avoided. 1 1 is therefore probable, that 
the eruption is the effed of fweatmg ; and 
that it is the produce of a matter, not before 
prevailing in the mafs of blood, but generat- 
ed, under particular circumftances, m the ikin 
itfelf That it depends upon particular cir- 
cumftances of the fkin, appears further from 
hence, that the eruption feldom or never ap- 
pears upon the face, although it affe6ls the 
whole of the body befides ; that it comes 
upon thofe places efpecially which are more 
clofely covered ; and that it can be brought 
out upon particular parts by external appli- 


It is to be obferved, that this eruptive dif- 
cafe differs from the other exanthemata in 
many circumftances ; in its not being conta- 
gious, and therefore never epidemic ; that the 
eruption appears at no determined period of 
the difeafe ; that the eruption has no deter- 
mined duration ; that fucceffive eruptions fre- 
quently appear in the courfe of the fame fe- 
ver ; and that fuch eruptions frequently recur 
in the courfe of the fame perfon's life. 

All thefe circumftances render it extremely 
probable, that, in the miliary fever, the mor- 
bific matter is not a fubfifting contagion com- 
municated to the Wood, and thence, in confe- 
quence of fever and affimilation, thrown out 
E 4 "PO^ 


upon the furface of the body ; but a matter 
occafionally produced in the fkin itlclf, by 


This conclufion is further rendered proba- 
ble from hence, that, while the miliary erup- 
tion has no pecuHar fymptoms, or concourfe 
of fymptoms, belonging to it ; yet, upon oc- 
casion, it accompanies almoft all febrile difeaf- 
es, whether inflammatory or putrid, if thefe 
happen to be attended with fweating ; and 
from thence it may be prefumed, that the mil- 
iary eruption is a fymptomatic affeftion only, 
produced in the manner we have faid. 


But, as this fymptomatic affeftion does not 
always accompany every inftance of fweating, 
it may be proper to inquire, what are the cir- 
cumfiances which efpecially determine this e- 
ruption to appear ? To this, however, I can 
give no full and proper anfwer. I cannot 
lay that there is any one circumftance which 
in all cafes gives occafion to this eruption ; 
nor can I fay what different caufes may, in 
different cafes, give occafion to it. There is 
only one obfervation I can ofi^er to the pur- 
pofe of this inquiry ; and it is, that, of the 
perfons fweating under febrile difeafes, thofe 
-ire efpecially liable to the miliary eruption, 



who have been previoufly weakened hy large 
evacuations, particularly of blood. This will 
explain why it happens to lying in women 
more frequently than to any other perfons ; 
and to confirm this explanation, I have re- 
marked, that the eruption happened to women 
not in childbed, but who had been much 
fubje6led to a frequent and copious menftru- 
ation, and to an almoft conflant fluor albus. 
I have alfo had occafion to obferve" it happen 
to men in fevers, after wounds from which 
they had fullered a great lofs of blood.. 

Further, that this eruption is produced by 
a certain Hate of debility, will appear proba- 
ble, from its often occurring in fevers of the 
putrid kind, which are always attended with 
great debility. It is true, that it alfo fome- 
times attends inflammatory difeafes, when it 
cannot be accounted for in the lame manner ; 
but I believe it will be found to attend efpec- 
ia'lly thofe inflammatory difeafes in which tlii; 
fweats have been long protra6led or frequent- 
ly repeated, and which have thereby produc- 
ed a debility, and perhaps a debilitating pu- 
trid diathefis. 


It appears fo clearly to me that this erup- 
tion is always a fymptomatic and faftitious af- 
fcftion, that I am perfuaded it may be in moil 
cafes prevented m.erely by avoiding fweats,. 
Spontaneous fweatings, in the beginning of 

Vol. 2. K 5 difeafes,. 


difeafes, are very rarely critical ; all fwcatings^ 
not evidently critical, Ihould be prevented ; 
and the promoting them, by increafing exter- 
nal heat, is commonly very pernicious. Even 
critical fweats fhould hardly be encouraged 
by fuch means. If, therefore, fpontaneous 
fweats arife, they are to be checked by the 
coolnefs of the chamber ; by the lightnefs and 
loofenefs of the bed clothes ; by the perfons 
laying out their hands and arms, and by their 
taking cold drink ; and, by thefe precautions, 
I think I have frequently prevented miliary 
eruptions, which were otherwife likely to have 
appeared, particularly in lying in women. 


But it rrtay happen, when thefe precautions 
liave been neglefied, or from other circum- 
llances, th^t a miliary eruption does aftually 
appear ; and the queftionwiil then be put, how 
the cafe is to be treated ? It is a queftion of 
confequence, becaufe I believe that the matter 
here generated is often of a virulent kind; it 
IS frequently the ofFspring.of putrefcency ; and, 
when treated by increasing the external heat 
of the body, it feems to acquire a virulence 
which produces thofe fymptoms mentioned in 
DCCXIX, and proves certainly fatal. 

It has been an unhappy opinion with moft 
phyficians, that eruptive difeafes were ready 
to be hurt by cold ; and that it was therefore 
ncceffary to cover up the body very clofely, fo 



as thereby to increafe the external heat. We 
now know that this is a miftaken opinion ; 
that increafing the external heat of the body 
is very generally mifchievous ; and that lev- 
eral eruptions not only admit, but require the 
application of cold air. We are now pcrfuad- 
ed,, that the praftice which formerly prevailed, 
in the cafe of miliary eruptions, of covering 
up the body clofe, and both by external 
rneans, and internal remedies, encouraging 
the fweatings which accompany this eruption,, 
was highly pernicious, and commonly fatal. 
I am therefore of opinion, even when a milia- 
ry eruption has appeared, that in all cafes 
where the fweating is not manifeftly critical, 
we fliould employ all the feveral means of 
flopping it that are mentioned above ; and I 
have fometimes had occafion to obferve, that 
even the admiffion of cool air was fafe and;, 


This is, in general, the treatment of miliary 
eruptions ; but, at the fame time, the remedies- 
fuited to the primary drfeafe are to be employ- 
ed ; and therefore, when the eruption happens 
to accompany inflammatory affeftions, and 
when the fulnefs and hardnefs of the pulfe or 
other fymptoms fhow an inflammatory ftate 
prefent, the cafe is to be treated by bToodlet- 
ting, purging, and other antiphlogiftic rem- 

E6 Upoac 


Upon the other hand, when the miliary 
eruption attends difeafes in which debility and 
putrefcency prevail, it will be proper to avoid 
all evacuations, and employ tonic and antifep- 
tic remedies, particularly the Peruvian bark, 
cold drink, and cold air. 

I fhall conclude this fubjefl; with mention- 
ing, that the venerable odogenarian prafti- 
tioner, de Fifcher, when treating of this fub- 
jeft, in laying down the indications of cure, 
has given this as one of them : * Excretionis 

* periphericse non primariam habere ratio- 

* nem.' 







1 HE Nettle Rafh is a name 
applied to two different difeafes. The one is 
the chronic eruption defcribed by Dr. He- 
berden in the Medical Tranfaftions, Vol. I. 
art. xvii. which, as not being a febrile diforder, 
does not belong to this place. The other is 
the Urticaria of our Synopfis, which, as taken 
into every fyftem of Nofology as one of the 
Exanthemata Febrilia, is properly to be treat- 
ed of here. 


I have never obferved this difeafe as conta- 
gious and epidemic J and the few fporadic cafes 



of it which have occurred to me/ have feldom 
taken the regular courfe defcribcd hy authors. 
At the fame time, as the accounts of different 
authors are not very uniform, and hardly con- 
fident, I cannot enter further into the confid- 
eration of this fubje6l ; and I hope it is not 
very necelfary, as on all hands it is agreed to be 
a mild difeafe, and fuch as feldom requires the 
ufe of remedies. It is generally fufficient to 
obferve an antiphlogiflic regimen, and to keep 
the patient in a temperature that is neither 
hot nor cold. 


The Pemphigus, or Veficular fever, is a 
rare and uncommon difeafe, and very few in- 
ftances of it are recorded in the writings of phy~ 
ficians. As I have never had occafion to fee 
It, It would be improper for me to treat of it ; 
and I do not choofe to repeat after others^ 
while the difeafe has yet been little obferved, 
and its charafter does not feem to be exadly 
afcertained. Vid. Aaa Helvetica, vol. ii. p. 
260. Synopf. Nofolog. vol. ii. p. i^p. 


The Aphtha, or Thrufh, is a difeafe better 
known ; and, as it commonly appears in in- 
fants, it is fo well underftood, as not to need 
our treating of it here. As an idiopathic dif, 
eafe, affeamg adults, I have not fcen it in this 

country ; 


country ; but it feems to be more frequent in 
Holland'; and, therefore, for the fludy of it, I 
refer to Dr. Boerhaave, and his commentator 
Van Swieten, whofe works are in every body's 


The Petechia has been, by all our Nofolo- 
gifts, enumerated amongft the exanthemata ; 
but as, according to the opinion of moft phy- 
ficians, it is very juftly held to be always a 
fymptomatic affeftion only, I cannot give it 
a place here. 











IN eftablifliing a clafs or or- 
der of difeafes, under the title of Hemorrha- 
giesy Nofologifls have employed the fingle 
circumftance of an eflFufion of red blood, as 
the charafter of fuch a clafs or order. By this 
means, they have alTociated difeafes which in 
their nature are very different ; but, in every 
methodical diftribution, fuch arbitrary and 
unnatural alfociations fhould be avoided as ^ 
much as poffible. Further, by that manage- ^ 


O F P H Y S I C. 101 

ment Nofclogifls have fuppreffed or loPc fight 
of an eftablifiied and well founded diftin6lion 
of hemorrhagiesinto A6live and Paffive. 


It is my dcfign to reftore this diftin6lion ; 
and I Ihall therefore here, under the title of 
Hemorrhagies, comprehend thofe only which 
have been commonly called A6live, that is, 
thofe attended with fome degree of pyrexia ; 
which feem always to depend upon an increaf- 
ed impetus of the blood in the veOTels pouring 
it out, and which chiefly arife from an inter- 
nal caufe. In this I follow Dr. Hoffman, 
who joins the aftive hemorrhagies with the fe- 
brile difeafes ; and have accordingly eflablifli- 
ed thefe hemorrhagies as an order in the clafs 
of pyrexia. From this order I exclude all 
thofe effulions of red blood that are owing en- 
tirely to external violence ; and all thofe which, 
though arifing from internal caufes, are, how- 
ever, not attended with pyrexia, and which 
feem to be owing to a putrid fluidity of the 
blood, to the weaknefs or to the erofion of the 
veffels, rather than to any increafed impetus 
of the blood in them. 


Before proceeding to treat of thofe proper 

hemorrhagies which form an order in our 

. Nofology, I fliall treat of aftive hemorrhagy 



in general ; and indeed the feveral genera and 
fpecies,tobe treated of particularly afterwards, 
have fo many circumftances in common with 
one another, that the general confideration to 
be now offered will prove both proper and 

Sect. I. 
OJ the Phenomena of Hemorrhagy. 


THE phenomena of hemorrhagy are gen- 
erally the following. 

Hemorrhagies happen efpecially in plethor- 
ic habits, and to perfons of a fanguine tem- 
perament. They appear moft commonly in 
the fpring, or in the beginning of fummer. 

For fome time, longer or Ihorter in differ- 
ent cafes, before the blood flows, there are 
fome fymptoms of fulnefs and tenfion about 
the parts from whence the blood is to iflue. 
In fuch parts as fall under our view, there are 
fome rednefs, fwelling, and fenfe of heat or of 
itching ; and in the internal parts, from which 
blood is to flow, there is a fenfe of weight and 
heat ; and, in both cafes, various pains are 
often felt in the neighbouring parts. 




When thefe fymptoms have fubfifted for 
fome time, fome degree of a cold ftage of py- 
rexia comes on, and a hot ftage is formed j 
during which, the blood flows of a florid col- 
our, in a greater or lefTer quantity, and contin- 
ues to flow for a longer or fhorter time ; but 
commonly, after fome time, the eff^ufion fpon- 
taneoufly ceafes, and together with it the py- 
rexia alfo. 


During the hot ftage which precedes an 
hemorrhagy, the pulfe is frequent, quick, full, 
and often hard ; but, as the blood flows, the 
pulfe becomes fofter and lefs frequent. 


In hemoiThagies, blood drawn from a vein 
does, upon its concreting, commonly fliow the 
gluten feparated, or a cruft formed, as in the 
cafes of Phlegraafiae. • 


Hemorrhagies, from internal caufes, hav- 
ing once happened, are apt, after a certain in- 
terval, to return ; in fome cafes very often, and 
frequently at ftated periods. 






Thefe are, in general, the phenomena < 
hemorrhagy ; and if in fome cafes all of theh. 
be not exquifitely marked, or if perhaps fome 
of them do not at all appear, it imports only, 
that, in different cafes, the fyftem is more or 
lefs generally affefted ; and that, in fome caf. 
es, there are purely topical hemorrhagies, 
th€re are purely topical inflammations. 

T. II. 

0/ the Proximate Cause of Hemor- 


THE pathology of hemorrhagy feems to be 
fufiiciently obvious. Some inequality in the 
diflribution of the blood, occafions acongcft- 
ion in particular parts of the fanguiferous 
fyftem ; that is, a greater quantity of bloo^ is 
poured into certain veffels than their natural 
capacity is fuited to receive. Thefe veffels 
become thereby preternaturally diftended ; 
and this diftention, proving a ftimulus to 
them, excites their aftion to a greater degree 
than ufual, which, puftiing the blood with un- 



ufual force into the extremities of thefe vefTels, 
opens them by anaftomofis, or rupture ; and^ 
if thefe extremities be loofely fituated on ex- 
ternal furfaces, or on the internal furfaces of 
certain cavities that open outwardly, a quanti- 
ty of blood flows out of the body. 


This reafoning will, in fome meafure, ex- 
plain the production of hemorrhagy. But it 
appears to me, that, in mofl cafes, there are 
fome other circumflances that concur to pro- 
duce it ; for it is probable, that in confequence 
of congeftipn, a fenfe of refillance arifes, and 
excites the aftion of the Vis Medicatiix Nn- 
turas ; the exertions of which are ufually made 
by the formation of a cold ftage of pyrexia, 
inducing a more vigorous a61ion of the vef- 
fels ; and the concurrence of this exertion 
more efFc6lually opens the extremities, and 
occafionsthe flowing out of the blood. 


What has been delivered in the two preced- 
ing paragraphs, feems to explain the whole 
phenomena of hemorrhagy, except the cir- 
cumftance of its frequent recurrence, which I 
apprehend may be explained in the following 
rnanner. The congelf ion and confequent ir- 
ritation being taken off by the flowing of the 
blood ; this, therefore, foon after, fpontane- 

• oufly 


oufly ceafes ; but, at the fame time, the in. 
ternal caufes which had before produced the 
unequal diftribution of the blood, commonly J 
remain, and mud now operate the more read- 1 
ily, as the overftretched and relaxed veffels of f 
the part will more eafily admit of a congeil- 
ion of blood in them, and, confequently, pro- 
duce the fame feries of phenomena as before. 


This may fufficiently explain the ordinary 
return of hemorrhagy ; but there is ftill an- 
other circumftance, which, as commonly con- 
curring, is to be taken notice of ; and that is, 
the general plethoric ftate of the fyftem, 
which renders every caufe of unequal diftri- 
bution of more conliderable efFeft. Though 
hemorrhagy may often depend upon the ftate 
of the veffels of a particular part being favour- 
abile to a congeftion's being formed iri them ; 
yet, in order to that ftate's producing its ef- 
fe61;, it is neceffary that the whole fyftem 
fhould be at leaft in its natural plethoric con- 
dition ; and, if this fhould be in any degree 
increafed beyond what is natural, it will ftill 
more certainly determine the eficfts of topical 
conformation to take place. The return of 
hemorrhagy, therefore, will be more cer- 
tainly occahoned, if the fyftem becomes pre- 
ternaturally plethoric ; but hemorrhagy has 
always a tendency to in'creafe the plethoVic 



• ftate of the fyftem, arid, confequently, to oc- 
•: cafion its own return. 


To Ihow that hemorrhagy does contribute 
li to produce or increafe the plethoric flate of 
the fyflem, it is only neceffary to obferve, 
that the quantity of lerous fluids being given, 
the ftate of the excretions depends upon a cer- 
tain balance between the force of the larger 
arteries propelling the blood, and the refift- 
1 ance of the excretories ; but the force of the 
■ arteries depends upon their fulnefs and dif- 
tention, chiefly given to them by the quanti- 
; ty of red globules and gluten, which are, for 
the greateft part, confined to the red arteries ; 
and therefore, the fpoliation made by an hem- 
orrhagy, being chiefly of red globules and 
gluten, the eff^ufion of blood mufl: leave the 
red arteries more empty and weak. In con- 
fequence of the weaker aftion of the red ar- 
teries, the excretions are in proportion dimin- 
iflied ; and, therefore, the ingefl;a continuing 
the fame, more fluids will be accumulated in 
the larger vefl"els. It is by this means that 
the lofs of blood by hemorrhagies, whether ar- 
tificial or fpontaneous, if within certain bounds, 
is commonly fo foon recovered ; but, as the 
diminution of the excretions, from a lefs 
quantity of fluid being impelled into the ex- 
cretories, gives occafion to thefe veflels to fall 
into a contra£led ftate ; fo, if this ftiall contin- 


ue long, thefe veffels will become more rigi^ 
and will not yield to the fameimpellingforceas 
before. Although the arteries, therefore, by 
new blood collefted in them, fhall have recov. i 
ered their former fulnefs, tenfion, and force ; 
yet this force will, not be in balance with the 
refiftance of the more rigid excretories, fo as 
to reftore the former Hate of excretion ; and, 
confequently, a further accumulation will take 
place in the arteries, and an increafe of their 
plethoric ftate be thereby induced. In this 
manner, we perceive more clearly, that hem- 
orrhagy, as producing a more plethoric ftate 
of the fyftem, has a tendency to occafion its 
own recurrence with greater violence ; and, 
a i the renewal and further accumulation of 
blood require a determinate time, fo, in the 
feveral repetitions of hemorrhagy, that time 
will be nearly the fame ; and therefore the re- 
turns of hemorrhagy will be commonly at 
flated periods, as ha^ been obferved frequent- 
ly to happen. 


I have thus explained the nature of hem- 
Oirhagy in general, as depending upon fome 
inequality in the difhribution of the blood, 
occafioning a congeftion of it in particu- 
lar parts of the fanguiferous fyftem. It is in- 
deed probable, that, in moft perfons, the fev- 
eral parts of the fanguiferous fyftem are in 
balance with one another ; and that the den- 



fity, and confequently the refiftance, in the 
feveral veffels, is in proportion to the quantity 
•of blood which each fhould receive ; from 
whence it frequently happens, that no ine- 
quahty in the diftribution of the blood takes 
place in the courfe of a long life. If, howev- 
er, we confider that the fanguiferous fyflem 
is conftantly in a plethoric ftate, that is, that 
the veffels are conftantly diftended beyond 
that fize which they would be if free from 
any diftending force, we fhall be fatisfied that 
this ftate may be readily changed. For as, 
on the one hand, the veffels are elaftic, fo as to 
be under a conftant tendency to contrafl; up- 
on the withdrawing of any part of the diftend- 
ing force ; and, on the other hand, are not fo 
rigid but that, by an increafe of the impetus 
of the blood in them, they may be more than 
ordinarily diftended ; fo we can eafily under- 
ftand how, in moft perfons, caufes of an in- 
creafed contraftion or diftention may arife in 
one part or other of the fyftem, or that an un- 
equal diftribution may take place ; and how, 
in an exquifitely diftended or plethoric fyftem, 
a fmall inequality in the diftribution of the 
blood may form thole congeftions which give 
occafion to hemorrhagy. 


In this manner I endeavour to explain how 
hemorrhagy may be occafioned at any period 
of life, or in any part of the body ; but hem- 

VoL. II. F orrhagies 


on hagies happen in certain parts -more fre- 
quently than in others, and at certain periods 
of Hfe more readily than at others ; and there- 
fore, in delivering the general doftrine of 
hemorrhagy, it may be required that I fhould 
explain thole circumftances which produce 
the rpecialities mentioned ; and I fhall noiv 
attempt it^ 


The human body, from being of a fmali 
bulk at its firfl formation, grows afterwards to 
a confiderable fize. This increafe of bulk 
confifts, in a great meafure, in the increafe of 
the quantity of fluids, and a proportional en- 
largement of the containing veflels. But, at 
the fame time, the quantity of folid matter is 
alfo gradually increafed ; and, in whatever 
manner we may fuppofe this to be done, it is 
probable that the progrefs, in the whole of 
the growth of animal bodies, depends upon 
the extenfion of the arterial fyftem ; and fuch 
is the conflitution of the fanguiferous fyftem, 
that the motion of the blood in the arteries 
has a conftant tendency to extend them in ev- 
ery dimenfion. 


As the ftate of the animal folid is, at the 
firft formation of the body, very lax and 
jielding ; fo the extenfion of the fyftem pro- 


ceeds, at firft, very faft ; but, as the extenfion 
gives occafion to the appofition of more mat- 
ter to the folid parts, thefe are, in proportion 
to their extenfion, conftantly acquiring a great- 
er denfity, and therefore giving more refin- 
ance to their further extenfion and growth. 
Accordingly, we obferve, that as the growth 
of the body advances, its increafe, in any giv- 
en time, becomes proportionally lefs and lefs, 
till at length it ceafes altogether. 


This is the general idea of the growth of 
the human body, till it attain the utmoft bulk 
which it is capable of acquiring ; but it is to 
be remarked, that this growth does not pro- 
ceed equally in every part ot" the body ; it 
being requifite for the economy of the fyftem, 
that certain parts ftiould be firfl; evolved, and 
fhould alfo acquire their full bulk fooner than 
others. This appears particularly with re- 
fpeft to the head ; the parts of which appear 
to be firfl evolved, and fooneft to acquire their 
full fize. 


To favour this unequal growth, it is pre- 
fumed, that the dimenfions or the laxity of 
the veffels of the head, or that the direction 
of the force of the blood, are adapted to the 
purpofe J and from what has been faid in 


DCCLII, it will alfo certainly follow, that as 
the vefTels of the head grow faflefl, and foon- 
efl acquire their full fize, fo they will fooneft 
alfo acquire that denfity which will prevent 
their further extenlion. While, however, the 
force of the heart, and the quantity of the flu- 
ids, with refpeft to the whole fyftem, remain 
the fame, the diftending and extending pow- 
ers will be direfted to fuch parts as have not 
yet acquired the fame denfity and dimenfions 
as thofe firft evolved ; and thus the diftending 
and extending powers will proceed to operate 
till every part of the fyftem, in refpeft of den- 
fity and reftftance, fliall have been brought to- 
be in balance with every other, and till the 
whole be in balance with the force of the heart, 
fo that there can be no further growth in any 
particular part, unlefs fome preternatural cir- 
cumftance fhall happen to arife. 


In this procefs of the growth of the body, 
as it feems in general to depend upon a cer- 
tain balance between the force of the heart or 
diftending power, and the refiftance of the 
folids ; fo it will appear, that, while the folids 
rernain very lax and yielding, fome occafion- 
al increafe of the diftending power may arife 
without producing any very perceptible dif- 
order in the fyftem. But, it will alfo appear, 
that, in proportion as the diftending power 
and refiftance of the folids come to be more 


OF PHY S'-I C. 113 

nearly in exaft balance with one another, fo 
any increafe of thediftending power will more 
readily produce a rupture of vcffcis, which 
do not-eafily yield to extenfion. 


From all this, it mull follow, that the ef- 
feds of any unufually plethoric flate of tha 
fyftem, will be different according as this ftiall 
occur at different periods of the growth of 
the body. Accordmgly, it is evident, that if 
the plethoric flate ariles while the head is yet 
growing, and while the determination of the 
blood is dill more to the head than to the 
other parts, the increafed quantity of the 
blood will be efpccially determined to the 
head ; and as there alfo, at the fame time, the 
balance between the diftending and extending 
powers is mofl nearly adjufted, fo the deter- 
mination of the blood will moft readily pro- 
duce in that part a rupture of the veffels, or an 
hemorrhagy. Hence it is, that hemorrhagics 
of the nofe fo frequently happen in young 
perfons ; and in thefe more readily, as they 
approach nearer to their acme, or full growth ; 
or, it may be faid, perhaps more prop- 
erly, as they approach nearer to the age of 
puberty, when perhaps, in both fexes, but ef- 
pecially in the female, a new determination 
arifes in the fyftem. 


114 P R A C T I C E 


The determination of a greater quantity of 
blood to the veffels of the head, might be fup- 
pofed to occalion a rupture of veiTels in other 
parts of the head as well as in the nofe ; but 
fuch a rupture does not commonly happen ; 
becaufe, m the nofe, there is, for the purpofe 
of fenfe, a coiifiderable network of blood vef- 
fels expanded on the internal furface of the 
riodriis, and covered onlv with thin and weak 
teguments. From this circumftance it is, that 
upon any increafed impetus of the blood in 
thevellels of the head, thofe of the nofe are 
mofl eafily broken ; and the effufion from the 
nofe taking place, it not only relieves the oth- 
er extremities of the external carotid, to which 
the arteries of the nofe chiefly belong, but 
relieves alfo, in a great meafurc, the fyftem of 
the internal carotid. For, from the internal 
carotid, certain branches are fent to the nofe, 
are fpread out on its internal furface, and 
probably inofculated with the extremities of 
the external carotid; fo that, whichfoever of 
the extremities are broken, the vis deriva- 
tionis of Haller will take place ; the effufion 
will relieve the whole fanguifcrous fyllem of 
the head ; and the fame effufion will alfo com- 
monly prevent an hemorrhagy happening at 
the fame time in any other part of the body. 




From thefe principles, it will appear why 
hemorrhagies of the nofe, fo frequent before 
the period of puberty, or of the acme, feldotn 
happen after thefe periods ; and I mufl ob- 
ferve further, that although they Ihould oc- 
cur, they would not afford any objeftion to 
my doftrine, as fuch hemorrhagies might be 
imputed to a peculiar laxity of the veffels of 
the nofe, and perhaps to a habit acquired with 
Tefpe6l to thefe velfels, while the balance of 
the fyftem might be otherwife duly adjufted. 


When the procefs of the growth of the 
bodv goes on regularly, and the balance of 
the fyllem is properly adjufted to the gradu- 
al growth of the whole, as well as to the fuc- 
ceffive growth of the fei'eral parts, even a ple- 
thoric fiate d»es not produce any hemorrhagy, 
or at leafl; any after that of the nofe ; but if, 
while the plethoric ftate continues, any ine-^ 
quality fhall alfo fubfift in any of the parts of 
the fyftem, congeftions, hemorrhagic or in- 
flammatory, may be ftill readily formed. 


In general, it may be obferved, that, when 

the leveral parts of the fyflemof the aorta 

F 4 have 


have attained their full growth, and are duly 
balanced with one another, if then any con- 
fiderable degree of plethora remain or arife, 
the nicety of the balance will be between the 
fyftems of the aorta and pulmonary artery, or 
between the veffels of the lungs and thofe of 
all the reft of the body. And although the 
lefler capacity of the veffels of the lungs is 
commonly compenfated by the greater veloci- 
ty of the blood in them j yet if this velocity 
be not always adjufted to the necefTary com- 
penfation, it is probable that a plethoric ftate 
of the whole body will always be efpecially 
felt in the lungs ; and therefore, that an hem- 
orrhagy, as the effeft of a general plethora, 
inay be frequently occafioned in the lungs, 
even though there be no fault in their eon- 


In fome cafes, perhaps, an hemorrhagy 
from the lungs, or an hemoptylis, does arife 
from the general plethoric ftate of the body ; 
but an hemoptyfis more frequently does, and, 
may be expefted to happen, from a faulty pro- 
portion between the capacity of the lungs and 
that of the reft of the body. 


When fuch a difproportion takes place, it 
uill be evident an hemoptyfis will efpec- 


iallv happen about the time that the body is 
approaching to its acrfie ; that is, when the 
Ivftem of the aorta has arrived at its utmolt 
extenfion and refillance, and when therefore, 
the plethoric ftate of the whole muft efpecial- 
ly affea the lungs. 


Accordingly it has been conRantly obferv- 
cd that the hemoptyfis efpecially occurs 
about the time of the body's arrivmg at its 
acme ; but I muft remark alfo, that the hem- 
orrhagy may occur fooner or later, according 
as the balance between the veffels of the lungs, 
and thofe of the fyftem of the aorta, happens 
to be more or lefs exadly adjufted to one an- 
other ; and it may therefore often occur much 
later than the period mentioned, when that 
balance, though not quite even, is however 
not fo ill adjuftcd, but that fome other con- 
curring caufes are neceffary to give it efFeft. 


It was anciently remarked by Hippocrates, 
and has been confirmed by modern obferva- 
tion, that the hemoptyfis generally occurs in 
perfons between the age of fifteen and that of 
five and thirty ; that "it may happen at any 
time between thefe two periods ; but that it 
feldom happens before the former, or after the 

Vol. 2. F 5 latter; 


latter ; and it may be proper here to inquire 
into the real'on of thcfe two limitations. 


With refpe6i: to the firfl, the reafon of it 
has been already explained in DCCLXII 

With refpeft to the fecond limitation, I 
expe6l that the reafon of it will be underftood 
from the following confiderations. 

It has been already obfen^ed, that the ex- 
tenfion and growth of the body require the 
plethoric ftate of the arterial fyftem ; and 
nature has provided for this, partly by the 
conflitution of the blood being fuch, that 
a great portion of it is unfit to pafs into the 
exhalants and excretories ; partly by giving 
a certain denfity and Tefiflance to the feveral 
exhalants and excretories through which the 
fluids might pafs out of the red arteries ; and 
partly, but efpecially, by a re fi fiance in the 
veins to the free paflage of the blood into 
them from the arteries. 


With refpea to this laR and chief circum- 
flance, it appears from the experiments of 
Sir Clifton Wintringham, in his Experiment- 
al Inquiry^ that the proportional denfity of 
the coats of the veins to that of the coats of 
the arteries, is greater in ycung than in old 

animals : 


animals: From which it may be pre fumed 
that the refinance to the pallage of the blood 
from the arteries into the veins, is greatei 
in young animals than in old; and, while this 
rchftance continues, the plethoric ilate of the 
arteries muft be conllantly continued and iup- 
ported. As however the denfity ot the coatt> 
of-the veffels, confiftiftg chiefly of a cellular 
texture, is increafed by preflare ; fo, m pro- 
portion as the coats of the arteries are more 
cxpofed to preifure by dillention than 
thofe of the veins, the former, in the prog-, 
refs of the growth of the body, muft increale 
much more in denfity than the latter ; and 
therefo«e the coats of the arteries, in refpea 
of denfity and refiftance, muft come in lime, 
-not only to be in balance with thofe of th-^- 
veins, but to prevail over them : A fadl which 
is fufficiently proved*by the experimeni ^ of 
the above mentioned ingenious autho) . 

By thefe means, the proportional quanli- 
tjes of blood in the arteries and veins muft 
change in the courfe of life. In younger 
animals, the quantity of blood in the arteries 
muft be proportionally greater than in old 
ones ; but, by the increafing denfity of the. 
arteries, the quantity of blood in them mail 
-be continually diminiftimg, and that in the 
veins be proportionally increafing, fo as at 
length to be in a proportionally greater quan- 
tity than that m'the arteries. When this 
change happens in the proportional quanti- 
ties of the blood in the arteries and veins, it 
F 6 muft 


mull be evident that the plethoric flate of the 
art tries will be in a great meafure taken off; 
and therefore that the arterial hemorrhagy is 
no longer likely to happen ; but that, if a 
general plethoric flate afterwards take place 
in the fyftem, it muft efpecially appear in 
the veins. 


The change I have mentioned to happen 
in the flate of the arterial and venous fyllems, 
is properly fuppofed to take place in the hu- 
man body about the age of thirty five ; when 
it is manifeft that the vigour of the body, 
which depends fo much upon the fulnefs and 
tenfion of the arterial fyflem, no longer 
increafes ; and therefore it is, that the fame 
age is the period, after which the arterial 
hemorrhagy, hemoptylis, hardly ever ap- 
pears. It is true there are inftances of the 
hemoptylis happening at a later period j but 
it is for the reafons given (DCCLVIII), 
which fhow that an hemorrhagy may happen 
at any period of life, from accidental caufes 
forming congeflions, independent of the flate 
of the balance of the fyftem at that particular 


I have faid (DCCLXVI), that if after 
the cige of thirty five, a general and preter- 


natural plethoric ft ate occur, it muft efpec- 
ially appear in the venous fyftem ; and I mufl 
now obferve, that this venous plethora may 
;ilfo give occafion to hemorrhagy. 


If a plethoric ftate of the venous fyftem 
take place, it is to be prefumed, that it will 
efpecially and in the firft place affe6l the fyf- 
tem of the vena portarum, in which the mo- 
tion of the venous blood is more flow than 
elfewhere; in which the motion of the blood 
is little affifted by external compreftion ; and 
in which, from the want of valves in the 
veins that form the vena portarum, the mo- 
tion of the blood is little affifted by the com- 
preffion that is applied ; while, from the fame 
want of valves in thofe veins, the blood is 
more ready to regurgitate in them. Wheth- 
er any regurgitation of the blood can pro- 
duce an aftion in the veins, and which invert- 
ed or dire6ted towards their extremities, can 
force thefe, and occafion hemorrhagy, may 
perhaps be dlfputed : But it appears to me, 
that an hemorrhagy, produced by a plethor- 
ic ftate of the veins, may be explained in 
another and more probable manner. If the 
blood be accumulated in the veins, from any 
interruption of its proper courfe, that accu- 
mulation muft reft ft the free paflage of the 
blood from the arteries into the veins. This, 
^gain, muft produce fome congeftion in the 



extremities of the red arteries, and therefore 
fome increafed a6lion in them, which mufl be 
determined with more than ufual force, 
both upon the extremities of the arteries, and 
upon the exhalants proceeding from them ; 
and this force may occafion an effufion of 
blood, either by anaflomofis or rupturq^ 


In this manner I apprehend the hemor- 
rhoidal flux is to be explained, fo far as it 
depends upon the Hate of the whole fyflein. 
It appears mod commonly to proceed from 
the extremities of the hemorrhoidal veflels; 
which being the mod dependent and diftant 
branches of thofe veins that form the vena 
portarum, are therefore the mofl readily af- 
fefted by every accumulation of blood in that 
fyftem of veins, and confequently by any 
general plethora in the venous fyllem. 


It is here to be obferved, that I have fpok- 
en of this hemorrhagy as proceeding from the 
hemorrhoidal vefTels only, as indeed it moil 
commonly does ; but it will be readily under- 
ftood, that the fame accumulation and refifU 
ance to the venous blood may, from various 
caufes, afFeft many of the extremities of the 
vena poita u n, which lie very fuperficially 
upon the int -rnal furface of the alnnentary 



canal, and give occafion to what has been 
called the Morbus Niger or Mclcena. 


Another part, in which an unufually ple- 
thoric ftate of the veins may have particular 
efFefts, and occafion hemorrhagy, is the head. 
In this, the venous fyftem is of a peculiar con- 
formation, and fuch as feems intended by na- 
ture to give there a flower motion to the ven- 
ous blood. If, therefore, the plethoric flate 
of the venous fyftem in general, which feems 
to increafe as life advances, fhould at length 
increafe to a great degree, it may very readily 
affeft the venous veflels of the head, and pro- 
duce there fuch a refiftance to the arterial 
blood, as to determine this to be poured out 
from the nofe, or into the cavity of the crani- 
um. The fpecial efFeft of the latter efFufion 
will be to produce the difeafe termed Apo- 
plexy ; and which, therefore, is properly 
named by Doftor Hoffman, Hamorrhagia 
Cerebri : And the explanation of its caufe, 
which I have now given, explains well why it 
happens efpecially to men of large heads and 
fliort necks, and to men in the decline of life, 
when the powers promoting the motion of the 
blood are much weakened. 


I have thus attempted to give "the hiftory 
of the plethoric and hemorrhagic ftates of 

> the 


the human body, as they occur at the difFer- 
ent periods of life ; and hope I have thereby 
explained, not only the nature of hemorrha, 
gy in general, but alfo of the particular hem- 
orrhagies which moft commonly appear, and 
as they occur fucceflively at the different pe- 
riods of life. 

Sect. hi. 
Of the Remote Causes o/"Hemorrhagy, 


IN the explanation hitherto given,! have 
efpecially conlidered the predifpofition to 
hemorrhagy ; but it is proper alfo, and even 
neceffary, to take notice of the occafional 
caufes, which not only concur with the pre- 
difponent, in exciting hemorrhagy, but may 
alfo fometimes be the fole caufes of it. 


Thefe occafional caufes are, 

1. External heat, which, by rarefying the 
blood, produces or increafes the plethoric 
ftate of the body ; and the fame heat, as giv- 
ing a ftimulus to the whole fyftem, mufl urge 
any particular determinations before eftabliih- 


O F P H Y S I C. 125 

ed, ftill further, or may urge to cxcefs any 
inequality, otherwife innocent ; fo that, in 
either way, external heat may immediately 
€xcite hemorrhagies, to which there was a 
predifpofition ; or may form congeflions 
where there were none before, and thereby oc- 
cafion hemorrhagy. 

2. A confiderable and fudden dimunition 
of the weight of the atmofphere, which feems to 
occafion the fame efFefts as heat, by produc- 
ing alfo an expanfion of the blood. 

3. Whatever increafes the force of the cir- 
culation, and thereby the velocity of the 
blood, may operate in the fame manner as 
heat, in urging not only previous determina- 
tions with violence, but alfo in urging to ex- 
cefs inequalities, otherwife innocent. All vi- 
olent exercife, therefore, and efpecially all 
violent efforts, which, not only by a larger 
and longer infpiration, but alfo, by the fimul- 
taneous aftion of many mufcles interrupting 
the free motion of the blood, impel it with un- 
ufual force into the extreme veffels more gen- 
erally, and, according to the different pof- 
tures of the body, and mode of the effort, into 
certain veffels more particularly. 

Among the caufes increafing the force of 
the circulation, anger and other violent adive 
paffions are to be reckoned. 

4. The violent exercife of particular parts 
of the body. If thefe are already affeded 
with congeftions, or liable to -them, fuch ex- 
ercife may be confidered as a ftimulus applied 



to the vefTels of that particular part. Thus, 
any violent exercife of refpiration may excite 
hemoptylis, or occafion its return. 

5. The poftures of the body increafing de- 
terminations, or ligatures occafioning accu- 
mulations of the blood ki particular parts of 
the body. 

6. A determination into certain veffels ren- 
dered habitual by the frequent repetition of 
hemorrhagy from them. 

7. Cold, externally applied, as changing 
the diftribution of the blood, and determin- 
ing it in greater quantity into the internal 



OJ the Cure of Hemorrhagy, 


^HAVING thus confidered the proximate 
and remote caufes of hemorrhagy in o-eneral, 
our next bufmefs is, to treat of the cui^ of the 
difeale in the fame manner. 

In entering upon this fubjeft, the firfl 
queflion which prefents itfelf, is. Whether 
the cure of hemorrhagies ought to be at- 
tempted by art, or if they Ihould be left to the 
condu6l of nature ? 


OF PHYSIC. .127 


The latter opinion was the favourite doc- 
trine of the celebrated Dr. Stahl, and his 
followers. They maintained, that the hu- 
man body is much difpofed to a plethoric 
ftate ; and, confequently, to many diiorders 
which nature endeavours to obviate and re- 
lieve by exciting hemorrhagy : That this, 
therefore, is often neceffary to the balance 
and health of the fyftem : That it is accord- 
ingly to be generally encouraged, iometimes 
folicited, and is not to be fuppreifed, unlets 
when it goes to great excefs, or happens in 
parts in which it may be dangerous 


Much of this doarine ma y be admitted. 
The human body, upon many occafions, be- 
comes preternaturally plethoric ; and the 
dangerous confequences which might from 
thence be apprehended, feem to be obviated 
by an hemorrhagy taking place : And, fur- 
ther, the neceffity of hemorrhagy often ap- 
pears from hence, that the fuppreffion of it 
feems to occafion many diforders. 

AH this feems to be juft ; but in the con- 
clufion drawn from it there is a fallacy. 




It appears to me certain, that hemorrhagy, 
cither upon its firfl attack, or upon its after 
recurrence, is never neceffary to the health of 
the body, excepting upon the fuppofition, 
that the plethoric ftate which feems to require 
the evacuation, cannot be oiherwife prevent- 
ed or removed ; and as I imagine it poffible 
by other means to prevent or remove a ple- 
thoric ftate, fo I do not think that hemorrhagy 
is, in all cafes, neceffary. In general, I am 
of opinion that hemorrhagy is to be avoided, 

1. Becaufe it does not always happen in 
parts where it is fafe. 

2. Becaufe often, while it does relieve a 
plethoric ftate, it may, at the fame time, in- 
duce a very dangerous difeafe. 

3- Becaufe it may often go to excefs, and 
either endanger life, or induce a dangerous 

And, laftly, Becaufe it has a tendency to 
increafe the plethoric ftate it was meant to re- 
lieve ; to occafion its own recurrence, 
(DCCXXI) ; and thereby to induce a habit, 
which, if left to the precarious and unequal 
operation of nature, may, from the frequent 
errors of this, be attended with much danger. 


It is further to be conlidered, that hemor- 
rhagies do not always arife from the neceffities 



of the fyftem, but often proceed from inci- 
dental caufes. It appears to me that all 
hemorrhagies of the latter kind may be im- 
mediately fuppreffed, and the repetition of ^ 
them, as it induces a plethora, and a habit 
not othei-wife neceffary, may be prevented 
with great advantage. 


Upon the whole of this fubjeft, I conclude, 
that every preternatural hemorrhagy, or, in 
other words, every one except that of the 
menfes in females, is to be avoided, and ef- 
pecially the returns of it prevented ; and I 
therefore now proceed to mention, how hem- 
orrhagy, and its recurrences, may, and 
Ihould be prevented. 


From the principles delivered above, it 
will immediately appear, that the prevention, 
either of the firft attacks, or of the returns of 
hemorrhagy, will chiefly, and in the firft 
place, depend upon the preventing or re- 
moving any confiderable degree of a plethoric 
ftate which may happen to prevail in the 
body. It is tme, that, where the hemorrhagy 
depends upon the particular conformation of 
certain parts, rather than upon the general 
plethoric ftate of the whole ; the meafures for 
removing or preventing the latter, may not 



always be fufficient for preventing hemorrha, 
gy : But at the fame time it muft be evident, 
that determinations in confequence of the 
conformation of particular parts, will always 
be urged more or lefs, in proportion to the 
greater or lefTer degree of the plethoric ftate of 
the whole fyllem ; and, therefore, that, even 
in the cafes depending upon particular con- 
formation, the preventing or removing an un- 
ufually plethoric ftate, will always be a chief 
means of preventing hemorrhagy. It is fur- 
ther to be attended to, that there may be fev- 
eral inequalities in the balance of the fyflem, 
which may have little or no efFe£l unlefs when 
the fyftem becomes preternaturally plethor- 
ic ; and therefore, that in cafes, the pre- 
venting or removing of the plethoric llate 
of the fyftemwill be a chief means of prevent- 
ing the firft attacks, or the returns of hemor- 
rhagy. It now, therefore, remains to ex- 
plain, how the plethoric ftate of the fyftem is 
to be prevented or removed. 


The fluids of the human body are in con- 
tinual wafte by the excretions, but are com- 
monly replaced by the aliments taken in; 
and if the quantity of aliments in any meafure 
exceed that of the excretions, an increafe of 
the quantity of the fluids of the body, or, in 
other words, a plethoric ftate, muft neceffarily 
arife. This, to a certain degree, is requifite for 



the growth of the body : But even then, if 
the proportion of the ahments to the excre- 
tions be greater than is fuited to the growth 
of the body; and more certainly ftill, if, 
after the growth is completed, when an 
equality between the ingefia and the -excreta 
fhould be eftabliOied, the difproportion ftill 
continue, a preternaturally plethoric ftate 
muft arife. In both cafes, it is evident, that 
the plethora muft be prevented or correfted 
by adjufting the ingefta and excreta to each 
other ; which generally may be done, either 
by diminiftiing the ingefta, or by increafmg 
the excreta. The former may be effe6ied by 
the management of diet, the latter by the 
management of exercife. 


The ingefta may be diminiflied, either by 
giving aliment in lefs quantity than ufual, or 
by giving aliments of a lefs nutritious quality; 
that is^ aliments of a fubftance, which, under 
the fame bulk and weight, contain lefs of a 
matter capable of being converted into animal 
fluids, and more of a matter ready to pafs 
off by the excretions, and confequently lefs of 
a matter to be retained and accumulated in 
the veffels. 

The choice of aliments fuited to thefe pur- 
pofes, muft be left to be direfted by the doc- 
trines of the Materia Medica. 




The inreafing of the excreta, and thereby 
^iminifhing the plethoric ftate of the fyftem 
is to beobtained by increafing the exer- 
<:ife of the body ; and generally for adjuft- 
ing the balance between the ingefta and ex- 
creta, and thereby obviating the plethoric 
ftate, it is neceffary that exercife, in a due 
meafure, be very conflantly employed. 


The obferving abftinence, and the em- 
ployment of exercife, for obviating or remov- 
ing the plethoric ftate of the body, were for- 
merly confidered pretty fully, when treating 
of the gout, (DXLVIIIj to DLII) ; fo 
that the lefs is neceffary to be faid here : And 
it is now only requifite to obferve, that the fame 
doubts, as in cafes of the gout, do not occur 
here with regard to the fafety of thofe meaf- 
ures, which, in a plethoric ftate of the body 
difpoling to hemorrhagy, are always admif- 
fible and proper. Here, however, it is to be 
obferved, that fome choice in the mode of ex- 
ercife is neceffary, and that it ftiould be dif- 
ferent according to the particular determina- 
tions which may happen to prevail in the fyf- 
tem. In general, in the cale of plethora dif- 
pofing to hemorrhagy, bodily exercife will 
always be hazardous, and geftation more 
commonly fafe. 




Artificial evacuations may be employed to 
diminifh the plethoric ftate of the body ; and 
when, at any time, it has become confidera- 
ble, and immediately threatens a difeafe, 
thefe evacuations fhould be made to the 
quantity that the fymptoms feem to require. 
But it is conftantly to be attended to, that 
bloodlettings are improperly employed to 
prevent a plethora, as they have a tendency 
toincreafeit (DCCXXI) ; and as they re- 
quire to be often repeated, and are thereby 
apt to induce a habit which may be attend- 
ed with much danger. 


While a plethora, and thereby the predif- 
pofition to hemorrhagy, is avoided, or re- 
moved, the other meafures neceffary for pre- 
venting the occurrence of this, are thofe for 
avoiding the remote caufes. Thefe have 
been enumerated in (DCCLXXV) ; and 
the means of avoiding them, lb far as within 
our power, are fufficiently obvious. 


Having thus mentioned the means of pre- 
venting either the fir ft attacks, or the recur- 
rence of hemorrhagy ; I muft next fay how 

Vol. II. G it 

134 P R A C T I C |: 

it is to be managed when it has aftually come 


When an hemorrhagy has come on which 
appears to have arifen from a preternaturally 
plethoric ftate, or from fome change m the 
balance of the fanguiferous fyftem, no meaf- 
ures are to be immediately taken for fup- 
prefling it ; as we may expe6l, that, when 
the quantity of blood neceifary for the re- 
lief of the fyftem is poured out, the effufion 
will fpontaneoufly c^afe. 


In many cafes, however, it may be fuf- 
pe6led, that the quantity of blood poured 
out, is not exaftly in proportion to the ne- 
ceffities of the fyftem, either for relieving a 
creneral plethora or a particular congeftion, 
but that it is often to a greater quantity than 
thefe require. This we fuppofe to happen 
in confequence of an inflammatory diathefis 
prevailing, and of a febrile fpafm being 
formed ; and therefore it is in many cafes 
proper, as well as for the moft part fafe, to 
moderate the evacuation ; and when it threat- 
ens to go to excefs, to fupprefs it altogether. 


O.F P H Y S I C. 135 


An hemorrhagy may be moderated by 
avoiding any irritation that might concur to 
increafe it; fo that every part of the anti- 
phlogiflic regimen is to be obferved ; in par- 
ticular external heat, both as it rarefies the 
fluids, and flimulates the folids, is to be care-' 
fully avoided : And it is probable, that in all 
cafes an hemorrhagy may be fafely moderated 
by cool air applied, and cold drink exhibited. 


A fecond means for the fame purpofe, is 
the ufe of refrigerant medicines, and partic- 
ularly of acids and nitre. 


A ' third means which has been frequently 
employed, is that of bloodletting. The pro- 
priety of this praftice may be doubtful, as 
the quantity of blood poured out by the hem- 
orrhagy may be fuppofed to anfwer the 
purpofe of an evacuation in any other way ; 
and I am ready to allow, that the praftice 
has been often fuperfluous, and fometimes 
hurtful, by making a greater evacuation than 
was necelfary or fafe. At the fame time, I 
apprehend it is not for the mere purpofe of 
evacuating, that bloodletting is to be prac- 
tifed in the cure of hemorrhagy ; but that it 
G 2 is 


is further neceflary for taking off the inflam- 
matory diathefis which prevails, and the fe- 
brile fpafm that has been formed. Accord- 
ingly, in the cafe of hemorrhagy, when the 
pulfe is not only frequent but quick and full, 
and does not become fofter or flower upon 
the flowing of the blood, and that the effu- 
fion is profufe, and threatens to continue fo, 
it appears to me, that bloodletting may be 
neceflary, and I have often found it ufeful. 
It feems probable alfo, that the particular cir- 
cumftances of venefeftion may render it more 
powerful for taking off the tenfion and in- 
flammatory irritation of the fyftem, than any 
gradual flow from an artery. 


That a fpafm of the extreme veflels has a 
fhare in fupporting hemorrhagy, appears to 
me probable from hence, that bliftering has 
been often found ufeful in moderating and 
fupprefling the difeafe. 


Do emetics and vomiting contribute to the 
cure of hemorrhagy ? See Dr. Bryan Rob- 
inson on the Virtues and Power of Med- 


When an hemorrhagy is very profufe, and 
feems to endanger life, or even threatens to 



induce a dangerous mfirmity, it is agreed on 
all hands, that it is to be immediately fuppre li- 
ed by every means in our power ; and partic- 
ularly, that, br^fides the means above men- 
tioned for moderating the difeafe, aftringents, 
internal or external where the latter can be ap- 
plied, are to be employed for fuppreffing it. 


The internal aftringents are eithei; vegeta- 
ble or foffil. 

The vegetable aftringents are feldom very 
powerful in the cure of any hemorrhagies, 
except thofe of the aUmentary canal. 

The fofiTil aftringents are more powerful ; 
but fome choice amongft the dift'erent kinds 
may be proper. 

- The chalybeates, fo frequently employed, 
do not appear to me to be very powerful. 

The preparations of lead are certainly more 
fo ; but are otherwife of fo pernicious a qual- 
ity, that they ftiould not be employed ex- 
cept in cafes of the utmoft danger. The 
Tinftura Saturnina, or Antiphthifica, as it 
has been called, appears to be of little effi- 
cacy ; but whether from the fmall portion of 
lead which it contains, or from the ftate in 
which the lead is in it, I am uncertain. 

The foflil aftringent that appears to me the 
moft powerful, and at the fame time the moft 
lafe, is alum. 




External aflringents, when they can be ap, 
plied, are more efFedlual than the internal. 
The choice of thefe is left to the furgeons. 


The mofl powerful of all aflringents ap- 
pears to me to be cold, which may be em- 
ployed, either by applying cold water to the 
furface of the body, or by throwing it into 
the internal parts. 


For fupprefling hemorrhagies, many fu- 
perftitious remedies and charms have been 
recommended, and pretended to have been 
employed with fuccefs. The feeming fuc- 
cefs of thefe, however, has been generally 
owing to the byftanders' miflakinga fpontane- 
Ous ceafmg of the hemorrhagy for the efFeft 
of the remedy. At the fame time, I believe, 
that thofe remedies may have been fome- 
times ufeful, by imprelling the mind with 
horror, awe, or dread. 


Upon occafion of profufe hemorrhagies, 
opiates have been employed with ^^advantage ; 



and, when the fulnefs and inflammatory di~ 
athefis of the fyftem have been previoufly 
taken off by the hemorrhagy itfelf, or by 
bloodletting, I think opiates may be em- 
ployed with fafety. 


For reflraining hemorrhagy, ligatures have 
been applied upon the limbs, in the view of 
retarding the return of the venous blood from 
the extremities ; but they appear to me lo 
be of uncertain and ambiguous ufe. 


In the cafe of profufe hemorrhagies, no 
pains are to be taken to prevent a Deliquium 
Animi, or fainting, as the happening of this 
is often the moft certain means of flopping the 


Having thus delivered the general doflrinc 
of hemorrhagy, I proceed to confider the 
particular cafes of it. It may perhaps be re- 
marked, that I have marked fewer of thcfe 
than are commonly enumerated by the nofol- 
ogifts ; but my reafons for differing from 
thefe authors, muft be left to a nofological 
difcuffion, to be entered into elfewhere more 
properly than here. 

G 4 CHAP. 


CHAP. 11. 



1 HE ftate of the veffels upon 
the internal furface of the nofe being fuch as 
already mentioned (DCCLVII), renders an 
hemorrhagy from that more frequent than 
from any other part of the body. 


The blood commonly flows from one nof- 
tril only ; and probably becaufe an hemor- 
rhagy from one veflel relieves the congeftion 
in all the neighbouring veflels. 

The blood flowing from both noftrils at 
the fame time, ftiows commonly a more con. 
fiderable difeafe. 


OF PHYSIC. 141' 


This hemorrhagy happens to perfons of e\''- 
eiy conflitution and temperamenf, but moll 
frequently to thofe of a plethoric habit and 
fanguine temperament. It happens to both 
fexes, but moll frequently to the male. 


This hemorrhagy may occur at any time 
of life ; but rnofl commonly happens to 
young perfons, owing to the flate of the bal- 
ance of the fyftem peculiar to that age, as. 
mentioned in (DCCLVI.) 


Although generally it happens to perfons 
before they have arrived at their full growtli 
and more rarely afterwards ; yet fometimcs 
it happens to perfons after their acme, and 
during the ftate of manhood : And it mufl 
then be imputed to an unufually plethoric 
flate of the fyftem ; to an habitual determina- 
tion of the blood to the veflTels of the nofe ; 
or to the particular weaknefs of thefe. 


.In all thefe cafes the difcafe may be con-. 

fidered as an hemorrhagy purely arterial, and 

Vol. 2 G 5 depending. 


depending upon an arterial plethora j but it 
fometimes occurs in the declin^ of life, when 
probably it depends upon and may be con- 
fidered as a mark of a venous plethora of the 
veffels of the head. See DCCLXXII. 


This hemorrhagy happens alfo at any pe- 
riod of life, in certain febrile difeafes, which 
are altogether or partly of an inflammatory 
nature, and which fhow a particular deter- 
mination of the blood to the veflels of the 
head. Thefe difeafes often admit of a folu- 
tion by this hemorrhagy, when it may be 
properly termed critical. 


The difeafe fometimes comes on without 
any previous fymptoms ; particularly when 
fome external violence has a fliare in produc- 
ing it. But when it proceeds entirely from 
an internal caufe, it is commonly preceded 
by headachs, rednefs of the QyQ.?,y a florid col- 
our of the face, an unufual pulfation in the 
temples, a fenfe of fulnefs about the nofe, 
and an itching of the noftrils. A bound bel- 
ly, pale urine, coldnefs of the feet, and cold 
fhivering over the whole body, are alfo fome- 
times among the fymptoms that precede the 




From the weaknefs of the vefTels of the nofe,, 
the blood often flows from them without an)r 
confiderable effort of the whole fyftem, and 
therefore without any obfervable febrile dif- 
ofder ; which, however, in many cafes, is,. 
in aU its circumftances, very difcernible. 


m An hemorrhagy of the nofe happening to 
young perfons, is, and may generally be,, 
confidered as a flight difeafe of little 'confc- 
quence, and hardly requiring any remedy. 
But, even in young perlbns, when it recurs 
very frequently, and is very copious, it will 
require particular attention, as it is to be 
confidered as a mark of arterial plethora ; and 
as frequently returning, .it may increafe the 
plethoric ftate ; which in a more advanced 
flage of life, may give the blood a determina- 
tion to parts from which the hemorrhagy 
would be more dangerous. All this will 
more particularly require attention, accord- 
ing as the marks of plethora, and of particu- 
lar congeftion, preceding the hemorrhagy, 
are more confiderable : and as the flowino of 
the blood is attended with a more confidera- 
ble degree of febrile diforder. 

G 6 Dcccxvr. 




When the epiftaxis happens to perfons 
after their acme, returning frequently, and 
flowing copioufly, it is always to be confid- 
ered as a dangerous difeafe, and as more 
certainly threatening the confequences men- 
tioned in thelaft paragraph. 


When this hemorrhagy happens in the 
decline of life, it may be confidered as in it- 
felf very falutary : But at the fame time, it is 
to be confidered as a mark of a very dan- 
gerous ftate of the fyftem ; that is, as a mark 
of a very ftrong tendency to a venous pleth- 
ora in the veffels of the head : And I have 
accordingly obferved it often followed by 
apoplexy^ palfy, or fuch like difeafes^ 


When an hemorrhagy frown the nofe hap- 
pens in febrile difeafes, as mentioned in 
DCCCXII, and is in pretty large quantity, 
it may be confidered as critical and falutary ; 
but it is very apt to be profufe, and even in 
this way dangerous. 

It upon fome. occafions occurs during the 
eruptive fever of feveral exanthemata, and is 
in fuch cafes fometimes falutary j but, if thefe 



exanthemata be accompanied with any putrid 
tendency, this hemorrhagy, like artificial 
bloodlettings, may have very bad efFefts. 


Having thus explained the feveral circum- 
ftances of epillaxis, I proceed to confider the 
management and cure of it. I ufe the ex- 
preffion of management, becaufe it has been 
ufuaily thought to require no cure, but that 
'nature ftiould be allowed to throw out blood 
in this way very frequently ; and as often as 
it appears to arife from internal caufes, that 
is, from a ftate of the fyftem fuppofed to re- 
quire fuch evacuation. 


" I am however of opinion, for the reafons 
given in DCCLXXIX, that this difeafe is 
very feldom to be left to the conduft of na- 
ture ; and that in all cafes it (hould be mode- 
rated by keeping the patient in cool air ; by 
giving cold drink ; by keeping the body and 
head ereft ; by avoiding any blowing of the 
• nofe, fpeaking, or other irritation : And> 
when the blood has flowed for fome time, 
without fhowing any tendency to ceafe, a 
profufe bleeding is to be prevented by meaf- 
ures employed to flop it, fuch asprefling the 
noftrii from wbich the blood flows, waftiing 



the face with cold water, or applying this to 
other parts of the body. 


Even in the cafe of young perfons, where 
the difeafe is lead hazardous, and even in 
the firfl attacks, I judge fuch meafures to be 
proper : But they will be ftill more proper 
if the difeafe frequently recurs without any 
external violence ; if the returns fhall happen 
to perfons of a habit difpofedto be plethoric; 
and more particularly, if the marks of a ple- 
thoric ftate appear in the precedent fymp- 


Even in young perfons, if the bleeding 
be very profufe and long continued, and 
more efpecially if the pulfe become weak and 
the face pale, I apprehend it will be proper 
to fupprefs the hemorrhagy by every means 
in our power. See DCtxCVII, and fol- 
lowing paragraphs. 


Further, in the fame cafe of young perfons, 
when the returns of this hemorrhagy become 
frequent, and efpecially with the marks of a 
plethoric habit, I think it necelfary to employ 
fuch a regimen as may prevent a plethoric 




At the fame time, care fliould be taken to 
avoid all circumftances which may determine 
the blood more fully to the velTels of the head 
or prevent its free return from them • and* 
by keepmg an open belly to make fome de- 
rivation from them. 


In adult perfons, liable to frequent returns 
of the epiftaxis, the whole of the meafures 
propofed (DCCCXXIII) are more certain. 
ly and freely to be employed. When with 
the circumftances mentioned in DCCCXIII 
the tendency to a profufe hemorrhagy ap- 
pears, a bleeding at the arm may be proper- 
even in young perfons ; but in the cafe of a- 
dults, it will be ftill more allowable, and 
even necellary. 


In perfons of any age liable to frequent 
returns of this hemorrhagy, when the meaf- 
ures propofed in DCCCXVII, et feg. fhall 
have been negkaed, or from peculiar cir- 
cumftances in the balance of the fyftem, ftiall 
have proved ineffet^ual, and the fymptoms 
threatemng hemorrhagy (DCCCXXXVIII ) 
Ihall appear, it will then be proper, by blood- 
ietting, cooling purgatives, and every part 
ot the antiphlogiftic regimen, to prevent the 



hemorrhagy, or at leaft to prevent its being 
profuie when it does happen. 


In the circumftances juft now mentioned 
(DCCCXXV), the meafures propofed are 
proper, and even neceflary ; but it ftiould 
at the fame time be obferved, that thefe are 
pra6lifed with much lefs advantage than thofe 
pointed out in DCCCXXIV : Becaufe, 
though thofe fuggefted here may prevent the 
coming on of the hemorrhagy for the prefent, 
they certainly, hoAvever, difpofc to the return 
of that plethoric ftate which required their be- 
ing ufed ; and there can be no proper fecu- 
rity againft returns of the difeafe, but by pur- 
fu'ingthe means propofed in DCCCXXIII. 


When the hemorrhagy of the nofe hap- 
pens to perfons approaching to their full 
growth, and when its returns have been pre- 
ceded by the fymptoms DCCCXIII, it 
may be fuppofed, that, if the returns can 
be prevented by the meafures propofed in 
DCCCXXV, thefe may be fafely employed; 
as the plethoric ftate -induced will be render- 
ed fafe, by the change which is foon to take 
place in the balance of the fyftem. This, 
however, cannot be admitted ; as the evacu- 
ations pradifed upon this plan will have all 



OF PHYSIC. • 149 

the confequences which, I have already ob- 
ferved, may follow the recurrence ot the 
hemorrhagy itfelf. 


When the hemorrhagy of the nofe (hall 
be found to make its returns at n^rly ftated 
periods, the meafures for preventmg it 
(DCCCXXV) maybe praQifed with great 
certainty ; and, upon every repetition of 
bloodletting, by diminilhing the quantity 
taken away, its tendency to induce a pletho- 
ra may be in fome meafure avoided. When 
indeed, the repetition of evacuations is truly 
unavoidable, the diminifhing them upon 
every repetition is properly pra6lifed : But 
it is a praftice of nice and precarious manage- 
ment, and fhould by no means be trufted to, 
fo far as to fuperfede the meafures propofed in 
DCCCXXV, wherever thefe can be admit- 


When the hemorrhagy of the nofe hap- 
pens in confequence of a venous plethora in 
the veffels of the head, as in DCCLXXII, 
the flowing of the blood pretty largely may 
be allowed, efpecially when it happens after 
the fupprefhon or ceafing of the menftrual 
or hemorrhoidal flux. But though the flow- 
ing of the blood is, on its fir ft occurring, to 



be allowed, there is nothing more proper 
than guarding againft its returns. This is to be 
done not only by the mea^res propofed in 
DCCLXXXIII, et feq. but, as the efFeas 
of a plethoric ftate of the veffels of the head 
are very uncertain ; fo, upon any appearance 
of it, and efpecially upon any threatening of 
hemorrhagy, the plethora is to be removed, 
and the hemorrhagy to be obviated immedi- 
ately by proper evacuations, as bloodletting, 
purging, and iffues ; or by reftoring fup- 
preifed evacuations, where this can be done. 






Sect. I. 

0/ the Phenomena and Causes of 


VV HEN, after fome affec- 
tion of the breaft, blood is thrown out from 
the mouth, and is brought out with more or 
lefs of coughing, there can be no doubt that 
it comes from the lungs ; and this generally 
afcertains the cKfeafe of which I am now to 
treat. But there are which the fource 
of the blood fpit out is uncertain ; and there- 
fore fome other confiderations, to be mention- 


ed hereafter, are often neceflary to afcertain 
the exiflence of an hemoptyfis. 


The blood vefTels of the lungs are more nu- 
merous than thofeof any other part of the bo- 
dy of the fame bulk. Thefe veffels of the larg- 
eft fize, as they arife from the heart, are more 
immediately than in any other part fubdivid- 
ed into vefTels of the fmalleft fize ; and thefe 
fmall velfels fpread out near to the internal 
furfaces of the bronchial cavities, are fituated 
in a loofe cellular texture, and covered by a 
tender membrane only ; So that, confidering 
how readily and frequently thefe vefTels are 
gorged with blood, we may underfland why 
an hemorrhagy from them is, next to that of 
the nofe, the moft frequent of any ; and par- 
ticularly, why any violent fhock given to the 
whole body fo readily occafions an hemop- 



An hemoptyfis may be occafioned by ex- 
ternal violence, at any period of life ; and I 
have explained above (DCCLX), why, in 
adult perfons, while the arterial plethora Hill 
prevails in the fyflem, that is, from the age of 
fixteen to that of five and thirty, an hemop- 


tyfis may at any time be produced, merely 
by a plethoric flate of the lungs. 


But it has been alfo obferved above, 
(DCCLXI), that an hemoptyfis more fre- 
quently arifes from a faulty proportion be- 
tween the capacity of the vefTels of the lungs 
and that of thofe of the reft of the body. 
Accordingly it is often a hereditary difeafe, 
which implies a peculiar and faulty confor- 
mation. And the difeafe alfo happens ef- 
pecially to perfons who difcover the fmaller 
capacity of their lungs, by the narrownefs of 
their cheft, and by the prominency of their 
fhoulders ; which laft is a mark of their hav- 
ing been long liable to a difficult refpiration. 


With thefe circumftances alfo the difeafe 
happens efpecially to perfons of a fanguine 
temperament; in whom particularly, the ar- 
terial plethora prevails. It happens likewife 
to perfons of a /lender delicate make, of 
which a long neck is a mark ; to perfons of 
much fenfibility and irritability, and therefore 
of quick parts, whofe bodies are generally 
of a delicate ftrufture ; to perfons who have 
been formerly liable to frequent hemorrha- 
gies of the nofe ; to perfons who have fuffer- 
ed a fuppreffion of any hemorrhagy they had 



formerly been liable to, the moft frequent 
inftance of which is in females who have fuf- 
fered a fuppreflion of their menftrual flux ; 
and, laftly, to perfons who have fuffered the 
amputation of any confiderable limb. 


In mofl ofthefe cafes (DCCCXXXIVJ, 
the difeafe happens efpecially to perfons 
about the time of their coming to their full 
growth, or foon after it, and this for the rea- 
fons fully fet forth above. 


From all that has been faid froirr 
difponent caufe of hemoptyfis will be fuffi- 
ciently underflood, and the difeafe may hap- 
pen from the mere circumftance of the pre- 
difponent caufe arifing to a confiderable de- 
gree. In the predifpofed, however, it is 
often^ brought on by the concurrence of va- 
rious occafional and exciting caufes. One of 
thefe, and perhaps a frequent one, is exter- 
nal heat ; which, even when in no great de- 
gree, will bring on the difeafe in fpring, and 
the beginning of fummer, while the heat ra- 
refies the blood more than ic relaxes the folids 
which had been before contrafted by the 
cold of winter. Another exciting caufe is a 
fudden dimunition of the weight of the atmof- 


O F P H Y S I C. 155 

phere, efpecially when concurring with any 
effort in bodily exercife. This effort, too, 
alone, may often, in the predifpofed, be the 
exciting caufe ; and more particularly, any 
violent exercife of refpiration. In fhort, in 
the predifpofed, any degree of external vio- 
lence alfo may bring on the difeafe. 


Occafioned by one or other of thefe caufes 
(DCCCXXXVI), the difeafe comes on with 
a fenfe of weight and anxiety in the cheft, 
fome uneafmefs in breathing, fome' pain of 
the breafl or other parts of the thorax, and 
fome fenfe- of heat under t|ie fternum ; and 
very often, before the difeafe appears, a 
faltifh talle is perceived in the mouth. 


Immediately before the appearance of 
blood, a degree of irritation is felt at the top 
of the larynx. To relieve this, a hawking is 
made, which brings up a little blood, of a 
florid colour, and fomewhat frothy. The ir- 
ritation returns ; and, in the fame manner, 
more blood of a like kind is brought up, with 
fome noife in the windpipe, as of air paffmg 
through a fluid. 




This is commonly the manner in which the 
hemoptyfis begins j but fometimes at the very 
firft the blood comes up by coughmg, or at 
leaft fomewhat of coughing accompanies the 
hawking jull now mentioned. 


The blood iffuing is fometimes at firft in 
very fmall quantity, and foon difappears 
altocrethcr: But, in other cafes, efpecially 
when it repeatedly occurs, it is m greater 
quantity, and frequently continues to appear 
at times for feveral days together. It is fome- 
times profufe ; but rarely in fuch quantity as 
either by its excefs, or by its fudden fuffoca- 
tion, to prove immediately mortal. It com- 
monly either ceafes fpontaneoufly, or is ftop- 
ped by the remedies employed. 


When blood is thrown out from the 
mouth, it is not always eafy to determine from 
what internal part it proceeds; whether from 
the internal furface of the mouth itfelf, from 
the fauces, or adjoining cavities of the nofe, 
from. the ftomach, or from the lungs. It is 
however, very neceffary to diftinguifh the 


O F P H Y S I C. 157 

different cafes ; and, in moft inftances, it 
may be done by attending to the following 


When the blood fpit out proceeds from 
fome part of the internal furface of the 
mouth itfelf, it comes out without any hawk- 
ing or coughing : And generally, upon in- 
fpeftion, the particular fource of it becomes 


When blood proceeds from the fauces, 
or adjoining cavities of the nofe, it may be 
brought out by hawking, and fometimes by 
coughing, in the manner we have deicribed 
fo that, in this way, a doubt may arife con- 
cerning its real fource. A patient often lays 
holdof thefe circumftances to pleafe himfelf 
with the opinion of its coming from the fau- 
ces, and he may be allowed to do fo : But a 
phyfician cannot readily be deceived, if he 
confider.that a bleeding from the fauces is more 
rare than one from the lungs ; that the former 
feldom happens but to perfons who have been 
before liable either to an hemorrhagy of the 
nofe, or to fome evident caufe of erofion ; 
and, in mod cafes, by looking into the fau- 
VoL. II. H ces. 


ces, the diftillation of the blood, if it comei- 
from thence, will be perceived. 


When blood proceeds from the lungs, the 
manner in which it is brought up will com- 
monly fhow from whence it comes : But in- 
dependent of that, there are may circumftanc- 
€s which may occur to point it out, fuch as the, 
period of life, the habit of body, and other 
DCCCXXXV); and, together with thefe, 
the occafional caufes (DCCCXXXVI) hav- 
ing been immediately before applied. 


When vomiting accompanies the throw- 
ing out of blood from the mouth, as vomit- 
ing and coughing often mutually excite each 
other ; fo they may be frequently joined, 
and render it doubtful, whether the blood 
thrown out proceeds from the lungs or from 
the ftomach. We may, however, generally 
decide, by confidering, that blood does not 
fo frequently proceed from the ftomach as 
from the lungs : That blood proceeding from 
the ftomach commonly appears in greater 
quantity, than when it proceeds from the 
lungs ; that the blood proceeding from the 
lungs is ufually of a florid colour, and mix- 
ed with a little frothy mucus only ; whereas 



the blood from the flomach is commonly of a 
darker colour, more grumous, and mixed 
with the other contents of the flomach : 
That the coughing or vomiting, according as 
the one or the other firfl arifes in the cafes in 
which they are afterwards joined, may fome- 
times point out the fource of the blood ; and, 
laftly, that much may be learned from the 
circumftances and fymptoms which have pre- 
ceded the hemorrhagy. 

Thofe which precede the hemoptyfis 
enumerated in DCCCXXXVII, are moa 
of them evident marks of an affe6tfon of the 
lungs. And, on the other hand, the hema- 
^;emefis, or iffuing of blood from the flomach, 
has alfo its peculiar fymptoms and circum- 
ftances preceding it ; as, for inllance, fome 
morbid affe£lion of this organ, or at lead 
fome pain, anxiety, and fenfe of weight, re- 
ferred diftin6lly to the region of the flomach. 
To all this may be added, that the vomiting 
of blood happens more frequently to females 
than to males ; and to the former,in con fequence 
of a fupprefTion of their menflrual flux : 
and, by attending to all thefe confiderations 
(DCCCXLII— DCCCXLV), the prefence 
of the hemoptyfis may commonly be fuffi- 
ciently afcertained« 

H 2 Sect. 


Sect. II. 

Of- the Cure o/" Hemoptysis. 


THIS difeafe is fometimes attended with 
little danger ; as, when it happens to fe- 
males in confequence of a fuppreffion of 
the menfes ; when, without any marks 
of a predifpofition, it arifes from external vio- 
lence ; or when, from whatever caufe arifing, 
it leaves behind it no cough, dyfpnoea, or 
other afFedion of the lungs. Even in fuch 
cafes, however, a danger may arife from too 
large an wound being made in the velfels of 
the lungs ; from a quantity of red blood be- 
ing left to ftagnate in the cavity of the bron- 
chias ; and particularly from any determina- 
tion of the blood being made into the vefTels 
of the lungs, which, by renewing the hemor- 
rhagy, may have dange/ous confequences. 
;^,- In every in (lance therefore of hemoptyfis, 
^ the effufion is to be moderated by the feveral 
means mentioned DCCXCII to DCCXCV. 




Thefe meafures are efpecially necelTary 
when the hemoptyfis arifes in confequence of 
predifpofition ; and in all cafes where there is 
the appearance of a large eflfufion, or where 
the hemorrhagy frequently returns,the effufion 
is not only to'be moderated, but to be entire- 
ly ftopped, and the returns of it prevented 
by every means in our power. See 
DCCXCVII, and following. 


To flop an hemoptyfis, or prevent the 
returns of it, two medicines have been fre- 
quently employed ; neither of which I can 
approve of. Thefe are, chalybeates, and the 
Peruvian bark. As both of them contribute 
to increafe the phlogiftic diathefis of the fyf- 
tem, they can hardly be fafe in any cafe of 
active hemorrhagy, and I have frequently 
found them hurtful. 


As the hemoptyfis, which happens in con- 
fequence of predifpofition, is always attend- 
ed with a phlogiftic diathefis ; and, as thesi 
badconfequences of the difeafe are efpecially 
to be apprehended from the continuance of 
that diathefis ; fo this is to be induftrioufly 
taken off by bloodletting, in greater or fmall- 
H3 er 


er quantity, and more or lefs frequently re- 
peated, according as the fymptoms fhall di- 
reft. At the fame time, cooling purgatives 
aic to be employed, and every part of the 
antiphlogiflic regimen is to be ftri6lly enjoin- 
ed. The refrigerants may alio be adminif- 
tered ; taking care, however, that the acids, 
and more efpecially the nitre, do not excite 



From what was obferved in DCCXCV, 
it will appear, that blillering upon the breaft 
or back may be a remedy of hemoptyfis, 
when it is prefent ; and that iffues in the 
fame places may be ufeful in preventing the 
giecurrence of it when it has ceafed. 


The avoiding of motion is generally a prop- 
er part of the antiphlogiflic regimen ; and 
in the hemoptyfis, n<[)thing is more neceffary 
than avoiding bodily exercife : But fome 
kinds of geftation, as failing, and travelling 
in an eafy carriage on fmooth roads, have 
often proved a remedy. 


Such is the treatment I can propofe for the 
hemoptyfis, confidered merely as an hemor- 

rhagy ; 

O F P H Y S I C. 1^5 

rliaffv : But when, in fpite of all our pre- 
caudons, it continues to recur it is often 
followed by an ulceration of the lungs and a 
phthifis pulmonalis. This, therefore, I mult 
now proceed to confider; but, as it arifes 
alfo from other caufes befides the hemoptyhs 
it mua be treated of with a more general 


H 4 CHAP. 




Sect. I. 

OJ the Phenomena and Causes oJ thi 
Phthisis Pulmonalis. 


The Phthifis Pulmonalis I 
would define to be, An expe6loration of pus 
or purulent matter from the lungs, attended 
with a he6lic fever. 

As this is the principal fpecies of phthifis, 
I fhall frequently in this chapter employ the 
general term of phthifis, though ftriftly 
meaning the phthifis pulmonalis. 




I have met with fome inftances of an ex- 
peftoration of purulent matter, continuing 
for many years, accompanied with very few^ 
fymptoms of heftic, and at leaft without any 
heftic exquifitely formed : But, in none of 
thefe inftances, were the perfons fo entirely 
free from fymptoms of heftic, as to form 
any exception to the general definition. 


In every mftance of an expectoration of 
pus, 1 prefume there is an ulceration of the 
lungs. The late Mr. de Haen is the only 
author that I know of who has advanced an- 
other opinion, and has fuppofed, that pus 
may be formed in the blood velTels, and be 
from thence poured into the bronchias. Ad- 
mitting his faft, I have attempted an expla- 
nation of the appearance of pus without ul- 
ceration in CCCXLIX : But, after all, I can- 
not help fufpefting the accuracy of his ob- 
fervations ; muft entirely rejeft his explana- 
tion of them; muft however allow, that we 
ftill want fafts to fupport the explanation I 
have offered -, and doubt much if it will ap- 
ply to any cafe of phthifis. For thefe reafons 
I ftill conclude, agreeably to the faith of all 
other diffe6lions, and the opinions of all 
phyficians, that the fymptoms mentioned in 

Vol. 2. H 5 our 


our definition depend always upon an ulcer- 
ation formed in the lungs. 


It has fometimes happened, that a catarrh 
was attended with an expe6loration of a mat- 
ter fo much refembling pus, that phyficians 
have been often uncertain whether it was 
mucus "or pus, and therefore whether the 
difeafe was a catarrh or a phthifis. It is oft- 
en of confequence to determine thefe quaf- 
tions ; and it appears to me that it may be 
generally done, with fufficient certainty, 
from the following confiderations, of which 
each particular is not always fingly decifive, 
but when they are taken together can hardly 
deceive us. 

1. From the colour of the matter ; as mu- 
cus is naturally tranfparent, and pus always 
opake. When mucus becomes opake, as it 
fometimes does, it becomes white, yel- 
low, or greenifh ; but the laft mentioned col- 
our is hardly ever fo remarkable in mucus as 
in pus. 

2. From the . confifhence ; as mucus is 
more vifcid and coherent, and pus lefs fo, and 
may be faid to be more friable. When mu- 
cus is thrown into water, it is not readily dif- 
fused, but remains united in uniform and cir- 
cular malTes : But pus, in the fame circum- 
ilajices, though not readily dilTufed, does not 


6 F PHYSIC. 167 

remain fo uniformly united and by a little 
aaitation is broken into ragged fragments, 
^o From the odour; which is ieldom per- 
ceived in mucus, but frequently in pus It 
has been propofed to try the odour of the 
matter expeaorated, by throwing it upon 
live coals : But in fuch a trial both mucus and 
pus dve out a difagreeable imell, and it is 
not eafy to diftingmfti between them. 

4 From the fpecific gravity compared 

with water ; and, indeed, it is ufual for the 
mucus of the lungs to iwim on the furface of 
water, and for pus to fink m it. But m this- 
we m?y fometimes be deceived; as pus 
which has entangled a great deal of air may 
fwim, and mucus that is free from air niay^in.^. 
c. From the mixture which is dilcerml^le 
in the matter brought up : For it a yellow or- 
greenifh matter appears furrounded with a 
quantity of tranfparent or lefs opake and lets- 
coloured matter, the more llrongly coloured 
matter may be generally confidered as pus j 
as it is not eafy to underftand how one por- 
tion of the mucus of the lungs can be very 
confiderably changed, while the reft of it 
is very little fo, or remains in its ordinary ftate. 
6. From the admixture of certain fubftanccs- 
with the matter thrown out from the lungs. 
To this purpofe we are informed by the ex- 
periments of the late Mr. Charles Darwm : 
a. That the vitriolic acid diflolves both mu- 
cus and pus, but mod readily the former : 
That if water be added to fitch a folulion ot 
' H 6 mucus,, 


mucus, this is feparated, and either fwims on 
the furface, or, divided into flocculi, is fuf- 
pended in the liquor ; whereas, when water 
is added to a like folution of pus, this falls to 
the bottom, or by agitation is diffufed fo as 
to exhibit an uniformly turpid liquor, b. 
That a folution of the cauftic fixed alkali, af- 
ter Ibme time, dififolves mucus, and generally 
pus ; and, if water be added to fuch folu- 
tions, the pus is precipitated, but the mucus 
is not. From fuch experiments it is fuppof- 
ed, that pus and mucus may be certainly dif- 
tinguiftied from each other. 

E^pm the expeftoration's being attended 
with a hedic fever. A catarrh, or expefto- 
ration of mucus, is often attended with fever ; 
but never, fo far as I have obferved, with 
fuch a fever as I am prefently to defcribe as a 
heftic. This, in my opinion, is the moft 
certain mark of a purulent flate in fome part 
of the body ; and if others have thought dif- 
ferently, I am perfuaded that it has been 
owing to this, that, pre fuming upon the mor- 
tal nature of a confirmed or purulent phthifis, 
they have confidercd every cafe in which a 
recovery happened, as a catarrh only : But, 
that they may have beenmiflaken in this,ftiall 
be fhown hereafter. 


Having thus confidered the firfl part of 
the charafter of the phthifis pulmonalis as a 



mark of an ulceration of the lungs ; and hav- 
ing juft now faid, that the other part of the 
chara6ler, that is, the heftic fever, is a mark 
or indication of the fame thing ; it is proper 
now to confider this here, as I had with 
that view omitted it before (LXXIVj. 


A heftic fever has the form of a remittent, 
which has exacerbations twice every day. 
The fir ft of thefe occurs about noon, fome- 
times a little fooner or later ; and a flight re- 
miflion of it happens about five afternoon. 
This laftisfoon fucceeded by another exacer- 
bation, gradually increafing till after mid- 
night : But after two o'clock of the morning, 
a remiflion takes place, which becomes more 
and more confiderable as the morning ad- 
vances. The exacerbations are frequently 
attended with fome degree of cold fhivering ; 
or at leaft, the patient is exceedingly fenfible 
to any coolnefs of the air, feeks external 
heat, and often complains of a fenfe of cold, 
when, to the thermometer, his flcin is preter- 
naturally warm. Of thefe exacerbations, 
that of the evening is always the moft con- 


It has commonly been given as a part 
of the character of a he6lic fever, that an ex- 




acerbation of it commonly appears after the 
taking food ; and it is true that dinner, 
which is taken at noon or after it, does feem 
to occafion fome exacerbation. But this 
muft not make us judge the midday exacer- 
bation to be the efFe6l of eating only; for I 
have often obferved it to come on an hour 
before noon, and often fome hours before 
dinner ; which, in this country at prefent, is 
not taken till fome time after noon. It is in- 
deed to be obferved, that in almoft every 
perfon, the taking food occafions fome de- 
gree of fever : But I am perfuaded this would 
not appear fo confiderable in a heftic, were it 
not that an exacerbation of fever is prefent 
from another caufe ; and accordingly, the 
taking food in the morning has hardly any 
fenfible eflPeft. 


I have thus defcribed the general form of 
he6lic fever ; but many circumftances attend- 
ing it are further to be taken notice of. 

The fever I have defcribed does not com- 
monly fubfift long, till the evening exacer- 
bations become attended with fweatings; 
which continue to recur, and to prove more 
and more profufe through the whole courfe 
of the difeafe. 

Almoft from the firft appearance of the 
heftic, the urine is high coloured, and depof- 
its a copious branny red fediment, which 



hardly ever falls clofe to the bottom of the 

In the heflic, the appetite for food is gen- 
erally lefs impaired than in any other kind of 

The thirfl is feldom confiderable ; the 
mouth is commonly moill ; and as the difeafe 
advances, the tongue becomes free from all 
fur, appears very clean ; and, in the advanced 
ftages of the difeafe, the tongue and fauces 
appear to be fomewhat inflamed, and become 
more or lefs covered, with aphthae. 

As the difeafe advances, the redveflels of the 
adnata of the eye difappear, and the whole 
of the adnata becomes of a pearly white. 

The face is commonly pale ; but, during 
the exacerbations, a florid red, and an almoll 
circumfcribed fpot, appear on each cheek. 

For fome time, in the courfe of a he61;ic, 
the belly is bound ; but, in the advanced 
ftages of it, a diarrhoea almoft always comes 
on, and continues to recur frequently during 
the reft; of the difeafe, alternating in fome 
meafure with the fweatings mentioned above. 

The difeafe is always attended with a debil- 
ity, which gradually increafes during the 
courfe of it. 

During the fame courfe an emaciation 
takes place, and goes to a greater degree than 
in almoft any other cafe. 

The falling off" of the hairs, and the adunque 
form of the nails, are alfo fymptoms of the 
want of nourifhment. 



Towards the end of the difeafe, the feet 
are often affefted with oedematous fweUings. 

The exacerbations of the fever are feldom 
attended with any headach, and fcarcely ever 
with delirium. 

The fenfes and judgment commonly remain 
entire to the very end of the difeafe ; and the 
mind, for the moft part, is confident and full 
of hope. 

Some days before death, a delirium comes 
on, and commonly continues to the end. 


The heflic fever now defcribed 
(DCCCLVIII, DCCCLIX) as accompany- 
ing a purulent ftate of the lungs, is perhaps 
the cafe in which it moft frequently appears ; 
but I have never feen it in any cafe, when 
there was not evidently, or when I had not 
ground to fuppofe, there was a permanent 
purulency or ulceration in fome external or 
internal part. It was for this reafon that in 
1.x XIV, I concluded it to be a fymptomatic 
fever only. Indeed, it appears to me to be 
always the efFeft of an acrimony abforbed 
from abfceffes or ulcers, although it is not 
equally the effeft of every fort of acrimony ; 
for the fcorbutic and cancerous kinds often 
fubfift long in the body v/ithout producing a 
heftic. What is the precife -ftate of the acri- 
mony producing this, I cannot determine, but 



it feems to be chiefly that of a vitiated puru- 


However this may be, it appears, that the 
beftic's depending in general upon an acrimo- 
ny, explains its peculiar circumftances. The 
febrile ftate feems to be chiefly an exacerba- 
tion of that frequency of the pulfe, which oc- 
curs twice every day to perfons in health, and 
may be produced by acrimony alone. Thefe 
exacerbations, indeed, do not happen without 
the proper circumfl:ances of pyrexia ; but the 
fpafm of the extreme veflels in a he6lic does 
not feem to be fo confiderable as in other fe- 
vers J and hence the ft;ate of fweat and urine 
which appears fo early and fo confl;antly in 
he£lics. Upon the fame fuppolition of an 
acrimony corrupting the fluids, and debilitat- 
ing the moving powers, I think that mofl; of 
the other fymptoms may alfo be explained. 


Having thus confidered the charafleriflical 
fymptoms and chief part of the proximate 
caufe of the phthifis pulmonalis, I proceed to 
obferve, that an ulcer of the lungs, and its 
concomitant circumftance of heftic fever, may 
arife from diff^erent previous affeftions of the 
lungs ; all of which however may, in my 
opinion, be referred to five heads ; that is, 

1. To 


1. To an hemoptyfis ; 2. To a fuppuratlon 
of the lungs in confequence of pneumonia j 
3. To catarrh ; 4. To afthma ; or, 5. To a 
tubercle. Thefe feveral afFeftions, as caufes 
of ulcers, fhall now be confidered in the or- 
der mentioned. 


It has been commonly fuppofed, that an 
hemoptyfis was naturally, and almoft necefla- 
rily, followed by an ulcer of the lungs. But 
I will prefume to fay, that, in general, this is 
a miftake ; for there have been many inftances 
of hemoptyfis occafioned by external violence, 
without being followed by any ulcer of the 
lungs ; and there have alfo been many in- 
ftances of hemoptyfis from an internal caufe, 
without any confequent ulceration. And 
this too has been the cafe, not only when the 
hemoptyfis happened to young perfons, and 
recurred for feveral times, but when it has 
often recurred during the courfe of a long 
life. It is indeed eafy to conceive, that a 
rupture of the veffels of the lungs, like that of 
the veffels of the nofe, may be often healed, 
as the furgeons fpeak, by the firfl intention. 
It is probable therefore, that it is an hemop- 
tyfis in particular circumftances only, which 
is neceffarily followed by an ulcer ; but what 
thefe circumftances are, it is difficult to deter- 
mine. It is poffible, that merely the de- 
gree of rupture, or frequently repeated rup- 


ture preventing the wound from healing by 
the firft intention, may occafion an ulcer ; or 
it is poffible that red blood efFufed, and not 
brought up entirely by coughing, may, by 
flagnating in the bronchias, become acrid, and 
erode the parts. Thefe however are but fuppo- 
fitions, not fupported by any clear evidence. 
And, if we confider that thofe cafes of he- 
moptyfis which follow the predifpofition 
efpecially which end in phthifis, we Ihall be 
led to fufpeft that there are fome other cir- 
cumftances which concur here to determine 
the confequence of hemoptyfiSj as I ihadl 
hereafter endeavour to ftiow. 


Any fuppofition, however, which we can 
make with refpeft to the innocence of an 
hemoptyfis, muft not fuperfede the meafures 
propofed above for its cure ; both becaufe we 
cannot certainly forefee what may be the con- 
fequences of fuch an accident, and becaufe 
the meafures above fuggefted are fafe ; for, 
upon every fuppofition, it is a diathefis phlo- 
giftica that may urge on every bad confe- 
quence to be apprehended. 


The fecond caufe of an ulceration of the 
lungs, to be confidered, is a fuppuration 
formed in confequence of pneumonia. 




From the fymptoms mentioned in 
DCCCLVIII, DCCCLIX, it may with 
reafon be concluded, that an abfcefs, or, as it 
is called, a vomica, is formed in fome part of 
the pleura, and moft frequently in that por- 
tion of it invefting the lungs. Here puru- 
lent matter frequently remains for fome time, 
as if inclofed in a cyft ; but commonly it is 
not long before it comes to be either abforb- 
ed, and transferred to fome other part of the 
body ; or that it breaks through into the cav- 
ity of the lungs, or into that of the thorax. In 
the latter cafe, it produces the difeafe called 
empyema ; but it is only when the matter is 
poured into the cavity of the bronchise, that 
it properly conftitutes the phthifis pulraona- 
lis. In the cafe of empyema, the chief cir- 
cumftances of a phthifis are indeed alfo pref- 
ent ; but I fliall here confider that cafe only 
in which the abfcefs of the lungs gives occa- 
fion to a purulent expe6loration. 


An abfcefs of the lungs, in confequence of 
pneumonia, is not always followed by a 
phthifis : For fometimes a he6lic fever is not 
formed ; the matter poured into the bronchiae 
is a proper and benign pus, which is frequent- 
ly coughed up very readily, and fpit out ; 


Q F PHYSIC. 177 

and, though this purulent expe6loration 
fhould continue for Ibme time, yet if a heftic 
does not come on, the ulcer foon heals, and 
every morbid fymptom difappears. This has 
happened (b frequently, that we may conclude, 
that neither the accefs of the air, nor the con- 
llant motion of the lungs, will prevent an ul- 
cer of thefe parts from healing, if the matter 
of it be well conditioned. An abfcefs of the 
lungs, therefore, does not neceffarily produce 
the phthifis pulmonalis ; and if it be followed 
by fuch a difeafe, it muft be in confequence 
of particular circumftances which corrupt the 
purulent matter produced, render it unfuitable 
to the healing of the ulcer, and at the fame 
time make it afford an acrimony, which, be- 
ing abforbed, produces a he6lic and its con- 


The corruption of the matter of fuch ab- 
fcefTes may be owing to feveral caufes ; as, 
1. That the matter efFufed during the in- 
flammation, had not been a pure ferum fit to 
be converted into a laudable pus, but had 
been united with other matters which pre- 
vented that, and gave a confiderable acrimony 
to the whole : Or, 2. That the matter efFuf- 
ed, and converted into pus, either merely by 
a long llagnation in a vomica, or by its con- 
nexion with an empyema, had been fo cor- 
rupted as to become unfit for the purpofe of 



pus, in the healing of the ulcer. Thefe feem 
to be poflible caufes of the cormption of mat- 
ter in abfcefles, fo as to make it the occafion 
of a phthifis in perfons otherwife found ; but 
it is probable, that a pneumonic abfcefs does 
efpecially produce phthifis when it happens 
to perfons previoufly difpofed to that difeafe, 
and therefore only as it concurs withfome oth- 
er caufes of it. 


The third caufe fuppofed to produce 
phthifis, is a catarrh ; which in many cafes 
leems, in length of time, to have the expedo- 
ration of mucus proper to it, gradually chang- 
ed into an expeftoration of pus ; and at the 
fame time, by the addition of a he6lic fever, 
the difeafe, which was at firft a pure catarrh, 
is converted into a phthifis. This fuppofi- 
tion, however, is not eafily to be admitted. 
The catarrh is properly an affeftion of the 
mucous glands of the trachea and bronchias, 
analogous to the coryza, and lefs violent kinds 
of cynanche tonfillaris, which very feldom 
terminate in fuppuration. And although a 
catarrh fhould be difpofed to fuch termina- 
tion, yet the ulcer produced might readily 
heal up, as it does in the cafe of a cynanche 
tonfilkris ; and therefore -fliould not produce 
a phthifis. 




Further^ the catarrh, as purely the efFe6l of 
cold, is generally a mild difeafe, as well as of 
Ihort duration ; and of the numerous inftances 
of it, there are at mod but very few cafes 
which can be faid to have ended in phthifis. 
In all thofe cafes^ in which this feems to have 
happened, it is to me probable that the per- 
fons affefted were peculiarly predifpofed to 
phthifis. And the beginning of phthifis fo 
often refembles a catarrh, tha,t the former may 
have been miftaken for the latter. Befides, 
to increafe the fallacy, it often happens that 
the application of cold, which is the moll fre- 
quent caufe of catarrh, is alfo frequently the 
exciting caufe of the cough which proves the 
beginning of phthifis. 


It is to me, therefore, probable, that a 
catarrh is very feldom the foundation of 
phthifis ; but I would not politively alTert 
that it never is fo ; for it is poffible that the 
cafes of a more violent catarrh may have 
joined with them, a pneumonic affe6lion, 
which may end in a fuppuration ; or it may 
liappen that a long continued catarrh, by the 
violent agitation of the lungs in coughing, 
will produce fome of thofe tubercles which 



are prefently to be mentioned as the mofl; 
frequent caufe of phthifis. 


It muft be particularly obferved here, that 
nothing faid in DCCCLXXII, ftiould aUow 
us to negleft any appearance of catarrh, as is 
too frequently done ; for it may be either the 
beginning of a phthifis, which is miftaken for 
a genuine catarrh ; or that even as a catarrh 
continuing long, it may produce a phthifis, 


Many phyficians have fuppofed an acrimo- 
ny of the fluids eroding fome of the velfels of 
T the lungs, to" be a frequent caufe of ulceration 
and phthifis. But this appears to me to be a 
mere fuppofition ; for in any of the inftances 
of the produftion of phthifis which I have 
feen, there was no evidence of any acrimony 
of the blood capable of eroding the velfels. 
It is true, indeed, that in many cafes an acri- 
mony fubfifting in fome part of the fluids, is 
the caufe of the difeafe ; but it is at the fame 
time probable, that this acrimony operates by 
producing tubercles, rather than by any di- 
re61; erofion. 




It has been mentioned in DCCCLXIII, 
that an afthma may be confidered as one of 
the caufes of phthifis ; and by afthma I mean, 
that fpecies of it which has been commonly 
named the Spafmodic. This diieafe frequent- 
ly fubfifts very long without producing any 
other, and may have its own peculiar fatal 
termination, as fhall be explained hereafter. 
But I have feen it frequently end in phthifis ; 
and in fuch cafes I luppofe it to operate in 
the manner above alleged of catarrh ; that is, 
by producing tubercles, and their confe- 
quences, which fhall be prefently mentioned. 


I come now to confider the fifth head of 
the caufe of phthifis, and which I apprehend 
to be the moft frequent of any. This I have 
faid, in general, to be tubercles ; by which 
term are meant, certain fmall tumours, which 
have the appearance of indurated glands. 
Diffeftions have frequently Ihown fuch tuber- 
cles formed in the lungs ; and although at 
firft indolent, yet at length they become in- 
flamed, and are thereby changed into little ab- 
fceffes, or vomicae ; which breaking, and 
pouring their matter into the bronchias, give 
a purulent expe6loration, and thus lay the 
foundation of phthifis. 




Though the matter expeftorated upon thefe 
•occalions has the appearance of pus, it is fel- 
dom that of a laudable kind ; and, as the ul- 
cers do not readily heal, but are attended 
with a heftic fever, for the mod part ending 
fatally, I prefume that the matter of the ul- 
cers is imbued with a peculiarly noxious ac- 
rimony, which prevents their healing, and 
produces a phthifis in all its circumflances, 
as mentioned above. 


It is very probabk that the acrimony which 
thus difcovers itfeif in the ulcers, exifted be- 
fore and produced the tubercles themfelves ; 
and it is to this acrimony that we muft trace 
up the caufe of th^e phthifis following thefe 
tubercles. This acrimony is probably, in 
different cafes, of different kinds ; and it will 
not be eafy to determine its varieties : But to 
a certain length I Ihali attempt it. 



In one cafe, and thaf, too, a very frequent 
one, of phthifis, it appears, that the noxious 
acrimony is of fhe fame kind with that which 
pK^yails in the fcrophula. This may be con- 
cliided from obferving, that a phthifis, at its 



ufual periods, frequently attacks perfons born 
of fcrophulous parents ; that is, of parents 
who had been affefted with fcrophula in their 
younger years : That very often, when the 
phthifis appears, there occur at the fame time 
fome lympathic tumours in the external 
parts ; and very often I have found the tabes 
mefenterica, which is a fcrophulous afFedion, 
joined with the phthifis pulmqnalis. To all 
this I would add, that, even when no fcrophu- 
lous affeftion has either manifeftly preceded 
or accompanied a phthifis, this laft, however, 
moft commonly affe6ls perfons of a habit re- 
fembling the fcrophulous ; that is, perfons of 
a fanguine, or of a fanguineo melancholic 
temperament, who have very fine fkins, rofy 
complexions, large veins, foft flefli, and thick 
upper lip : And further, that in fuch perfons 
the phthifis comes on in the fame manner 
that it does in perfons having tubercles, as 
fhall be immediately explained, 


Another fpecies of acrimony producing tu- 
bercles of the lungs, and thereby phthifis 
may be faid to be the exanthematic. It is 
well known, that the fmall pox fometimes, and 
more frequently the mealies, lay the founda- 
tion of phthifis. It is probable alfo, that oth- 
er exanthemata have the fame efFeft ; and 
from the phenomena of the difeafe, and the 
dilfeaions of perfons who have died of it, it is 
I 2 probable. 


probable, that all the exanthemata may occa- 
fion a phthifis, by affording a matter which 
in the firft place produces tubercles. 


Another acrimony, which feems fometimes 
to produce phthifis, is the fiphylitic : But 
whether fuch an acrimony produces phthilis 
in any other perfons than the previoufly dil- 
pofed, does not appear to me certain. 


What other fpecies of acrimony, fuch as 
from fcurvy, from pus abforbed from other 
parts of the body, from fuppreffed eruptions, 
or from other fources, may alio produce tuber- 
cles and phthifis, I cannot novy decide, but 
muft leave to be determined by thofe who 
have had experience of fuch cafes. 


There is one peculiar cafe of phthifis, which 
from my own experience I can take notice 
of This is the cafe of phthifis from a calca- 
reous matter formed in the lungs, and cough- 
ed up, frequently with a httle blood, lome- 
times with mucus only, and fometimes with 
pus How this matter is generated, or m 
what precife part of the lungs it is feated i 
acknowledge myfelf ignorant. In three cales 


of this kind which have occurred to me, there 
was at the lame time no appearance of ftony 
or earthy concretions in any other part of the 
body. In one of thefe cafes, an exquifitely 
formed phthifis came on, and proved mortal : 
While in the other two, the fymptoms of 
phthifis were never fully formed ; and after 
fome time, merely by a milk diet and avoid- 
ing irritation, the patients entirely recovered. 


Another foundation for phthifis, analogous, 
as I judge, to that of tubercles, is that which 
occurs to certain artificers whofe employments 
keep them almoft conftantly expofed to dull ; 
fuch as ftonecutters, millers, flaxdreffers, and 
fome others. I have not obferved in this 
country many inftances of phthifis which 
could be referred to this caufe ; but, from 
Ramazzini, Morgagni, and fome other 
writers, we muft conclude fuch cafes to be 
more frequent in the fouthern parts of Europe. 


Befides thefe now mentioned, there arc 
probably fome other caufes producing tuber- 
cles, which have not yet been afcertained by 
obfervation ; and it is likely, that in the ftate 
of tubercles there is a v^ariety not yet account- 
ed for : But all this mud be left to future ob- 
fervation and inquiry. 




It has been frequently fuppofed by phyfi- 
cians, that the phthifis is a contagious difeafe ; 
and I dare not afTert that it never is fuch : 
But in many hundred inftances of the difeafe 
which I have feen, there has been hardly one 
which to me could appear to have arifen from 
contagion. It is poffible, that in warmer cli- 
mates the efFe6ls of contagion may be more 

After having faid that a phthifis arifes from 
tubercles more frequently than from any oth- 
er caufe ,• and after having attempted to affign 
the variety of thefe, I now proceed to men- 
tion the peculiar circumftances and fymptoms 
which ufually accompany the coming on of 
the difeafe from tubercles. 


A tuberculous and purulent flate of the 
lungs has been obferved in very young 
children, and in fome others at feveral differ- 
ent periods before the age of puberty and full 
growth ; but inftances of this kind are rare ; 
and the attack of phthifis, which we have rea- 
fon to impute to^ubercles, ufually happens at 
the fame period which I have affigned for the 
coming on of the hemoptyfis. 


O F P H Y S I a 1^7 


The phthifis from tubercles does alfo gen- 
erally afFea the fame habits as the hemopty- 
fis ; that is, perfons of a flender make, ofloiig 
necks, narrow chefts, and promment ihom- 
ders : But very frequently the perfons liable 
to tubercles, have lefs of the florid counte- 
nance, and of the other marks of an exqui- 
fitely fanguine temperament, than the per- 
fons liable to hemoptyfis. 


This difeaCe, arifmg from tubercles, ufually , 
commences with a flight and ftiort cough, 
which becomes habitual, is often little remark- 
ed by thofe aflFeaed, and fometimes fo little as 
to be abfolutely denied by them. At the fame 
time their breathing becomes eafily hurried 
by any bodily motion, their body grows lean- 
er, and they become languid and indolent. 
This ftate fometimes continues for a year, or 
even for two years, without the perfons mak- 
ing any complaint of it, excepting only that 
they are afFe6led by cold more readily than 
ufual, which frequently increafes their cough, 
and produces fome catarrh. This, again, 
however, is fometimes relieved ; is fuppofed 
to have arifen from cold alone ; and therefore 
* gives no alarm either to the patient or to his 
I 4 friends, 


friends, nor leads them to take any precau- 


Upon one or other of thefe occafions of 
catching cold, as we commonly fpeak, the 
cough becomes more confiderable ; is partic- 
ularly troublefome upon the patient's lying 
down at night ; and in this ftate continues 
longer than is ufual in the cafe of a fimple 
catarrh. This is more efpecially to call for 
attention, if the increafe and continuance of 
cough come on during the fummer feafon. 


The cough which comes on as in 
DCCCLXXXIX,is veryoftenfor alongtime 
without any expeftoration ; but when, from 
repeatedly catching cold, it becomes more 
conftant, it is then at the fame time attended 
with fome expeftoration, which is moft con- 
fiderable in the mornings. The matter of 
this expeftoration becomes by degrees more 
copious, more vifcid, and more opake ; at 
length of a yellow or greenilh colour, and of 
a purulent appearance. The whole of the 
matter, however, is not always at once entire- 
ly changed in this manner ; but, while one 
part of it retains the ufual form of mucus, an- 
other fuffers the changes now defcribed. 




When the cough increafes, and continues 
very frequent through the night, and when 
the matter expeftorated undergoes the chang- 
es I have mentioned, the breathing at the 
fame time becomes more difficult, and the 
emaciation and weaknefs go on alfoincreafing. 
In the female fex, as the difeafe advances, and 
fometimes early in its progrefs, the menfes 
ceafe to flow ; and this circumftance is to be 
confidered as commonly the effeft, although 
the fex themfeives are ready to believe it the 
fole caufe of the difeafe. 


When the cough comes on as in 
DCCCLX XXIX, the pulfe is often natural, 
and for fome time after continues to be fo j 
but the fymptoms have feldom fubfifted long 
before the pulfe becomes frequent, and fome- 
times to a confiderable degree, without much 
of the other fymptoms of fever. At length, 
however, evening exacerbations become re- 
markable ; and by degrees the fever aflumes 
the exquifite form of heftic, as d-efcribed in 


It is feldom that the cough, expefloration, 

and fever, go on increafing, in the manner 

Vol. 2. I 5 now 

jgo P R A C T I CfE *• 

now defcribcd, without fome pain being felt 
in Tome part of the thorax. It is ufually and 
moft frequentl)'felt at firft under the fternum, 
and that efpecially, oralmoll only, upon occa- 
fion of coughing : But very often, and that 
too early, in the courfe of the difeafe, a pain 
IS felt on one fide, fomctimes very conftantly, 
and fo as to prevent the perfon from lying 
eafily upon that fide ; but at other times the 
pain is felt only upon a full infpiration, or 
upon coughing. Even when no pain is felt, 
it generally happens that phthifical perfons 
cannot lie eafily on fome one of their fides 
without having their difficulty of breathing 
increafed, and their cough excited. 


The phthifis begins, and fometimes pro- 
ceeds to its fatal iffue, in the manner defcribed 
without any appearance of hemoptyfis. Such 
cafes are, indeed, rare ; but it is very common 
for the difeafe to advance far, and even to an 
evident purulency and heftic ftate, without 
any appearance of blood in the fpitting : So 
that it may be affirmed, the difeafe is fre- 
quently not founded in hemoptyfis. At the 
fame time, we mufl allow, not only that it 
:fiometimes begins with an hemoptyfis, as is 
faidin DCCCLXIV ; but furthur, that it 
feldom happens that in the progrefs of the 
difeafe more or lefs of an hemoptyfis does not 



appear. Some degree of blood fpitting does, 
indeed, appear fometimes in the ftate men- 
more commonly in the more advanced Rages 
of the difeafe only, and particularly upon the 
firfl appearance of purulency. However this 
may be, it is feldom, in the phthifis from tu- 
bercles, that the hemoptyfis is confiderable, 
or requires an)^ remedies different from thofe 
which are otherwife neceffary for the flate of 
the tubercles. 


I have now defcribed a fucceflion of fymp- 
toms which, in different cafes, occupy more 
or lefs time. In this climate they very often 
take up fome years, the fymptoms appearing 
efpecially in the winter and fpring ; common- 
ly becoming eafier, and fometimes almoft dil- 
appearing, during the fummer : But returning 
again in winter, they at length, after two or 
three years, prove fatal, towards the end ott 
fpring or beginning of fummer. 


In this difeafe, the prognofis is for the m.oO: 
part unfavourable. Of thofe affefted with it, . 
the greater number die ; but there are alfo 
many of them who recover entirely, after 
having been in very unpromifing circum- 
fiances. What are^ however, the circum- 
1 6 " (l.-tiiceG-' 


fiances more certainly determining to a happy 
or to a fatal event, I have not yet been able to 


The following aphorifms are the refult of 
my obfervations. 

A phthifis pulmonalis from hemoptyfis, is 
more frequently recovered than one from tu- 

An hemoptyfis not only is not always fol- 
lowed by a phthifis, as we have faid above 
(DCCCLXIV) ; but even when followed by 
an ulceration, the ulceration is fometimes at- 
tended with little of heftic, and frequently 
admits of being foon healed. Even when the 
hemoptyfis and ulceration have happened to 
be repeated, there are inftances of perfons re- 
covering entirely after feveral fuch repetitions. 

A phthifis from a fuppuration in confe- 
quence of pneumonic inflammation, is that 
which moft rarely occurs in this climate ; and 
a phthifis does not always follow fuch fuppu- 
ration, when the abfcefs formed foon breaks 
and difcharges a laudable pus : But, if the ab- 
fcefs continue long fhut up, and till after a 
confiderable degree of he6lic has been form- 
ed, a phthifis is then produced, equally dan- 
gerous as that from other caufes. 

A phthifis from tubercles has, I think, been 
recovered : But it is of all others the moll 

dangerous ; 

OF P H Y S 1 C. 193 

dangerous ; and, when arifingfrom a heredita- 
ry taint, is almoft certainly fatal. 

The danger of a phthifis, from whatever 
caufe it may have an fen, is moft certainly to 
be judged of by the degree to which the hec- 
tic and its confequences have arrived. From 
a certain degree of emaciation, debility, pro- 
fufe fweating, and diarrhoea, no perfon re- 

A mania coming on, has been found to re- 
move all the fymptoms, and fometimes has 
entirely cured the difeafe ; but, in other cafes, 
upon the going off of the mania, the phthifis 
has recurred, and proved fatal. 

The pregnancy of women has often retard- 
ed the progrefs of a phthifis ; but commonly 
it is only till after delivery, when the fymp- 
toms of phthifis return with violence, and foon 
prove fatal. 

Sect. II. 

Of the Cure of Phthisis. 


FROM what has been juft now faid, it 
will readily appear, that the cure of the phthifis 
pulmonalis muft be exceedingly difficult ; and 
that even the utmoft care and attention in the 



employment of remedies have feldom fiic- 
ceeded. It may be doubtful whether this 
failure is to be imputed to the imperfe£lion 
of our art, or to the abfolutely incurable na- 
ture of the difeale. I am extremely avcrfe 
in any cafe to admit of the latter fuppofition, 
and can always readily allow of the former ; 
but, in the mean time, muft mention here 
what has been attempted towards either curing 
or moderating the violence of this difeafe, 


It muft be obvious, that, according to the 
different circumftances of this difeafe, the 
method of cure muft be different. Our firft 
attention fhould be employed in watching the 
approach of the difeafe, and preventing its 
proceeding to an incurable ftate. 

In all perfons of a phthifical habit, and cf- 
pecially in thofe born of phthifical parents, 
the flighteft fymptoms of the approach of 
phthifis, at the phthifical period of life, ought 
to be attended to. 


When an hemoptyfis occurs, though it be 
not always followed with ulceration and 
phthifis, thefe, however, are always to be ap- 
prehended ; and every precaution is to be 
taken againft them. This is efpecially to be 
done by employing every means of moderat- 

OF P H Y S X C. 195 

ing the hemorrhagy, and of preventing its re- 
turn, direaed in DCCCXCII, et feq. and 
thefe precautions ought to be continued for 
feveral years after the occurrence of the 


The phthifis which follows a fuppuration 
from pneumonic inflammation, can only be 
prevented with certainty, by obtaining a ref- 
olution of fuch inflammation. What may be 
attempted towards the cure of an abfcefs and 
ulcer which have taken place, I fhall fpeak of 


I have faid, it is doubtful if a genuine ca- 
tarrh ever produces a phthifis ; but have al- 
lowed that it poffibly may ; and both upon 
this account, and upon account of the ambi- 
guity which may arife, whether the appearing 
catarrh be a primary difeafe, or the effeft of a 
tubercle, I confider it as of confequence to 
cure a catarrh as foon as poffible after its firft 
appearance. More efpecially when it fhall 
linger, and continue for fome time, or fhall, 
after fome intermifTion, frequently return, the 
cure of it fhould be diligently attempted. 
The meafures requifite for this purpofe fhall 
be mentioned afterwards, when we come to 
treat of catarrh as a primary difeafe j but, in 



the mean time, the means neceffary for pre- 
venting its producing a phthifis fhall be men- 
tioned immediately, as they are the fame with 
thofe I fhall point out as neceffary for pre- 
venting a phthifis from tubercles. 


The preventing of a phthifis from afthma 
muft be, by curing, if poffible, the aflhma ; or 
at leaft by moderating it as much as may be 
done ; and as it is probable that aflhma occa- 
fions phthifis, by producing tubercles, the 
meafures neceffary for preventing phthifis 
from aflhma, will be the fame with thofe necef- 
fary in the cafe of tubercles, w^hich I am now 
about to mention. 


I confider tubercles as by much the mofl 
frequent caufe of phthifis j and even. in many 
cafes where this feems to depend upon he- 
moptyfis, catarrh, or aflhma, it does however 
truly arife from tubercles. It is upon this 
fubje£l, therefore, that I fhall have occafion 
to treat of the meafures mofl commonly requi- 
fite for curing phthifis. 


When, in a perfon born of phthifical pa- 
rents, of a phthifical habit, at the phthifical 


O F P H Y S I C. 197 

period oflife, the fymptomsDCCCLXXXIX, 
in the fpring, or beginning of fummer, ftiall 
appear in the flighteft degree, we may pre- 
fume that a tubercle, or tubercles, either have 
been formed, or are forming in the lungs ; and 
therefore, that every means we can devife for 
preventing their formation, or for procuring 
their refolution, fhould be employed imme- 
diately, even although the patient himfelf 
fliould overlook or negleft the fymptoms, as 
imputing them to accidental cold. 


This is certainly the general indication ; 
but how it may be executed I cannot readily 
fay. I do not know that, at any time, phy- 
ficians have propofed any remedy capable of 
preventing the formation of tubercles, or of 
refolving them when formed. The analogy 
of fcrophula, gives no afliftance in this matter. 
Infcrophula the remedies that are feemingly of 
moft power are, fea water, or certain mineral 
waters ; but thefe have generally proved hurt- 
ful in the cafe of tubercles of the lungs. I 
have known feveral inflances of mercury very 
fully employed for certain difeafes, in perfons 
who lyere fuppofed at the time to have tuber- 
cles formed, or forming, in their lungs ; but 
though the mercury proved a cure for thofe 
other difeafes, it was of no fervice in prevent- 
ing phthifis, and in fome cafes feemed to hur- 
ry it on. 




Such appears to me to be the prefent ftate 
of our art, with refpeft to the cure of tuber- 
cles ; but I do not defpair of a remedy for the 
purpofe being found hereafter. In the mean 
time, all that at prefent fecms to be within 
the reach of our art, is to take the meafures 
proper for avoiding the inflammation of tu- 
bercles. It is probable that tubercles may 
fubfift long without producing any diforder ; 
and I am difpofed to think, that nature fome- 
times refolves and difcuffes tubercles which 
have been formed ; but that nature does this 
only when the tul:)ercles remain in an unin- 
flamed flate ; and therefore, that the meafures, 
neceffary to be taken are chiefly thofe for a- 
voiding the inflammation of the tubercles. 


The inflammation of a tubercle of the lungs 
is to be avoided upon the general plan of a- 
voiding inflammation, by bloodletting, and 
by an antiphlogiftic regimen ; the chief part of 
which, in this cafe, is the ufe of a low diet. 
This fuppofes a total abftinence from animal 
food, and the ufing of vegetable food almoft 
alone ; but it has been found, that it is not 
neceflary for the patient to be confined to 
vegetables of the weakeft nourifliment, it be- 


ing fufficient that the farinacea be employed, 
and together with thefe, milk. 


Milk has been generally confidered as the 
chief remedy in phthifis, and in the cafe of 
every tendency to it j but whether from its 
peculiar qualities, or from its being of a lower 
quality, with refpe6l to nourilhment, than any 
food entirely animal, is not certainly deter- 
mined. The choice and adminiftration of 
milk will be properly direfted, by confidering 
the nature of the milk of the feveral animals 
from which it may be taken, and the particu- 
lar ftate of the patient with refpeft to the pe- 
riod and circumftances of the difeafe, and to 
the habits of his ftomach with refpe6l to milk. 


A fecond means of preventing the inflam- 
mation of the tubercles of the lungs, is, by a- 
voiding any particular irritation of the affeft- 
ed part, which may arife from any violent ex- 
ercife of refpiration j from any confiderable 
degree of bodily exercife ; from any pofition 
of the body which flraitens the capacity of 
the thorax ; and, laftly, from cold applied to 
the furface of the body, which determines the 
blood in greater quantity to the internal parts, 
and particularly to the lungs. 




From the laft mentioned confideration, the 
application of cold in general, and therefore 
the winter feafon, in cold climates, as dimin- 
ilhing the cutaneous perfpiration, is to be a- 
voided ; but more particularly, thai applica- 
tion of cold is to be (hunned that may fup- 
prefs perfpiration, to the degree of occafioning 
a catarrh, which confifts in an inflammatory 
determination to the lungs, and may therefore 
moft certainly produce an inflammation of 
the tubercles there. 

By confidering, that the avoiding heat is a 
part of the antiphlogiftic regimen above rec- 
ommended, and by comparing this with what 
has been jufl now faid refpefting the avoiding 
cold, the proper choice of climates and fea- 
fons for phthifical patients will be readily un- 


A third means of avoiding the inflamma- 
tion of the tubercles of the lungs confifts, in 
diminifhing the determination of the blood to, 
the lungs, by fupporting and increafing the 
determination to the furface of the body ; 
which is to be chiefly and moft fafely done 
by warm clothing, and the frequent ufe of the 
exercifes of geftation. 




Every mode of geftation has been found of 
ufe in phthifical cafes ; but riding on horfe- 
back, as being accompanied with a great deal 
of bodily exercife, is lefs fafe in perfons liable 
to an hemoptyfis. Travelling in a carriage, 
unlefs upon very fmooth roads, may alfo be 
of doubtful efFeft ; and all the modes of gef- 
tation that are employed on land, may fall 
ihort of the efFe6ls expefted from them, be- 
caufe they cannot be rendered fufficiently 
conftant : And therefore it is that failing, of 
all other modes of geftation, is the moft effec- 
tual in pneumonic cafes, as being both the 
fmootheft and moft conftant. 

It has been imagined, that fome benefit is 
derived from the ftate of the atmofphere upon 
the fea : But I cannot find that any impreg- 
nation of this which can be fuppofed to take 
place, can be of fervice to phtliifical perfons. 
It is however probable, that frequently fome 
benefit may be derived from the more mode- 
rate temperature and greater purity of the air 
upon the fea. 


In order to take off^ any inflammatory de- 
termination of the blood into the veflcis of the 
lungs, blifters applied to fome part of the 
thorax may often be of fervice ; and for the 



fame purpofe, as well as for moderating the 
general inflammatory Hate of the body, iffues 
of various kinds may be employed with ad- 



The feveral meafures to be purfued in the 
cafe of what is properly called an Incipient 
Phthifis, have now been mentioned ; but they 
have feldom been employed in fuch cafes in 
due time, and have therefore, perhaps, feldom 
proved eflFe6lual. It has more commonly 
happened, that after fome time, an inflam- 
mation has come upon the tubercle, and an 
abfcefs has been formed, which opening into 
the cavity of the bronchiae, has produced an 
ulcer, and a confirmed phthifis. 


In this ftate of matters, fome new indica- 
tions different from the former may be fup- 
pofed to arife ; and indications for preventing 
abforption, for preventing the effefts of 
the abforbed matter upon the blood, and 
for healing the ulcer, have been a6lually 
propofed. I cannot find, however, that, 
any of the means propofed for executing 
thefe indications, are either probable or have 
proved effeflual. If, upon fome occafions, 
they have appeared to be ufeful, it has been 
probably by anfwering fome other intention. 



"While no antidote againft the poifon which 
«fpccially operates here, (cems to have been 
as yet found out, it appears to me, that too 
great a degree of inflammation has a great 
Ihare in preventing the healing of the ulcer 
which occurs ; and fuch inflammation is cer- 
tainly what has a great fhare in urging on its 
fatal confequences. The only praftice, there- 
fore, which I can venture to propofe, is the 
fame in the ulcerated as in the crude ftate of 
a tubercle ; that is, the employment of means 
for moderating inflammation, which have 
been already mentioned DCCCClX et feq* 


The balfamics, whether natural or artificial, 
which have been fo commonly advifed in 
cafes of phthifis, appear to me to have been 
propofed upon no fufficient grounds, and to 
have proved commonly hurtful. The refin- 
ous and acrid fubftance of myrrh, lately rec- 
ommended, has not appeared to me to be of 
any fervice, and in fome cafes to have proved 


Mercury, fo often ufeful in healing ulcers, 
has been fpecioufly enough propofed in this 
difcafe ; but whether that it be not adapted to 
the particular nature of the ulcers of the lungs 
occurring in phthifis, or that it proved hurt- 


ful becaufe it cannot have efFeft without ex- 
citing fuch an inflammatory flate of the whole 
fyflem, as, in a he6lic ftate, mud prove very 
hurtful, I cannot determine. Upon many 
trials which I have feen made, it has proved 
of no fervice, and commonly has appeared to 
be manifeftly pernicious. 


The Peruvian bark has been recommended 
for feveral purpofes in phthifical cafes ; and 
is faid, upon fome occalions, to have been ufe- 
ful : But I have feldom found it to be fo j 
and as by its tonic power it increafes the 
phlogiflic diathefis of the fyflem, I have fre- 
quently found it hurtful. In fome cafes, 
where the morning remiflTions of the fever 
were confiderable, and the noon exacerbations 
well marked, I have obferved the Peruvian 
bark given in large quantities, have the efFeft 
of flopping thefe exacerbations, and at the 
fame time of relieving the whole of the phthif- 
ical fymptoms ; but in the cafes in which I 
obferved this, the fever fhowed a conflant 
tendency to recur ; and at length the phthif- 
ical fymptoms alfo returned, and proved 
quickly fatal. 


Acids of all kinds, as antifeptic and refrig- 
erant, are ufeful in cafes of phthifis ; but the 


O F P H Y S I C. 205 

native acid of vegetables is more ufeful than 
thefoffilacids,asit can be given 111 much larger 
quantities and may alfo be given more lately 
than vinegar, being lefs liable to excite cough- 


Though our art can do fo little towards the 
cure of this difeafe, we mufl, however, palli- 
ate the uneafy fymptoms of it as well as we 
can. The fymptoms efpecially urgent, are 
the cough and diarrhoea. The cough may 
be in fome meafure relieved by demulcents 
(DCCCLXXIII) : But the relief obtained 
by thefe is imperfed and tranfitory ; and very 
often the (lomach is difturbed by the quanti- 
ty of oily, mucilaginous, and fweet fubftances, 
which are on thele occafions taken into it. 


The only certain means of relieving the 
cough, is by employing opiates. Thefe, in- 
deed, certainly increafe the phlogiilic diathefis 
of the fyftem ; but commonly they do not 
fo much harm in this way, as they do fervice 
by quieting the cough, and giving fleep. 
They are fuppofed to be hurtful by checking 
expcftoration : But they do it for a fhort time 
only ; and, after a found fleep, the expe6fo- 
ration in the morning is more eafy than ufual. 
In the advanced ftate of the difeafe, opiates 

Vol. II. K feem 


feem to increafe the fweatings that occur ; but 
they compenfate this, by the eafe they afford 
in a difeale which cannot be cured, 


The diarrhoea which happens in the ad- 
I'anced ftate of this difeafe, is to be palliated 
by moderate aftringents, mucilages, and o- 

Rhubarb, fo commonly prefcribed in every 
diarrhoea, and all other purgatives, are ex- 
tremely dangerous in the colliquative diar- 
rhoea of hefliics. 

Frelh fubacid fruits, fuppofed to be always 
laxative, are often, in the diarrhoea of heftics, 
by their antifeptic quality, very ufeful. 








©/ the Phenomena and Caused of the 


A DISCHARGE of blood 
From fmall tumours on the verge of the anus, 
is the fymptom which "generally Gonftitutes the 
Hemorrhois ; or, as it is vulgarly called, the 
Hemorrhoidal Flux. But a difcharge of 
blood from within the anus, when the blood 
is of a florid colour, fhowing it to have come 
from no great diflance, is alfo confidered as 


the fame difeafe ; and phyficians have agreed 

in making two cafes or varieties of it, under 

K 2 the 


the names of External and Internal Hem- 


In both cafes it is fuppofed that the flow of 
blood is from tumours previoufly formed, 
which are named Hemorrhoids, or Piles ; and 
it frequently happens, that the tumours exifl; 
^vithout any difcharge of blood ; in wliich 
cafe, however, they are fuppofed to be a part 
of the fame difeafe, and are named Hemor«. 
rhoidcs Cascae, or Blind Piles. 


Thefe tumours, as they appear without the 
anus, are fometimes feparate, round, and 
prominent, on the verge of the anus ; but 
frequently the tumour is only one tumid ring, 
forming, as it were, the anus pufhed without 
the body. 


Thefe tumours, and the difcharge of blood 
from them, fometimes come on as an affe6lion 
purely topical, and without any previous dif- 
order in other parts of the body ; but it fre- 
quently happens, even before the tumours 
are formed, and more efpecially before the 
blood flows, that various diforders are felt in 
different parts of the body, as headach, verti- 


go, flupor, difficulty of breathing, ficknefs, 
colic pains, pain of the back and loins ; and 
often, together with more or fewer of thefe 
lymptonis, there occurs a con(iderable degree 
of pyrexia. 

The coming on of the difeafe with thefe 
fymptoms, is ufually attended with a fenfe of 
fuUnefs, heat, itching, and pain in and about 
the anus. 

Sometimes the difeafe is preceded by a dif- 
charge of ferous matter from the anus ; and 
fometimes this ferous difcharge, accompanied 
with fome fwelling, leems to be in place of 
the difcharge of blood, and to relieve thofe 
diforders of the fyflem which we have men- 
tioned. This ferous difcharge, therefore, has 
been named the Hemorrhois Alba. 


In the hemorrhois, the quantity of blood 
difcharged is different upon different occa- 
lions. Sometimes the blood flows only upon 
the perfon's going to ftool ; and commonly in 
larger or leffer quantity, follows the difcharge 
of the faeces. In other cafes, the blood flows 
without any difcharge of faeces ; and then, 
generally, it is after having been preceded by 
the diforders abovementioned, when it is alfo 
commonly in larger quantity. This difcharge 
of blood is often very confiderable ; and, by 
the repetition, it is often fo great, as we could 
hardly fuppofe the body to bear but with the 
K 3 hazard 


hazard of life. Indeed, though rarely, it haa 
been fo great as to prove luddenly fatal. 
Thefe confiderable difcharges occur efpecially 
to perfons who have been frequently liable to 
the difeafe. They often induce great debili- 
ty ; and frequently a leucophlegmatia, or 
dropfy, which proves fatal. 

The tumours and difcharges of blood in 
this difeafe, often recur at exaftly ftated 


It often happens, in the decline of life, that 
the hemorrhoidal flux, formerly frequent, 
ceafes to flow ; and, upon that event, it gen- 
erally happens that the perfons are affefled 
with apoplexy or palfy. 


Sometimes hemorrhoidal tumours are af- 
fefted with confiderable inflammation ; which, 
ending in fuppuration, gives occafion to the 
formation of fiflulous ulcers in thofe parts. 


The hemorrhoidal tumours have been often 
confidered as varicous tumours, or dilatations 
of veins ; and it is true, that in fome cafes va- 
ricous dilatations have appeared upon dilftc- 
tion, Thefe, however, do not always appear ; 



and I prefume it is not the ordinary cafe, but 
that the tumours are formed by an effufion of 
blood into the cellular texture of the inteftine 
near to its extremity. Thefe tumours, ef- 
pecially when recently formed, frequently 
contain fluid blood ; but, after they have re- 
mained for fome time, they are commonly of 
a firmer fubllance. 


From a confideration of their caufes, to be 
hereafter mentioned, it is fufficiently proba- 
ble, that hemorrhoidal tumours are produced 
by* fome interruption of the free return of 
blood from the veins of the lower extremit)^ 
of the redum ; and it is poflible, that a con- 
fiderable accumulation of blood in thefe veins, 
•may occafion a rupture of their extremities, 
and thus produce the hemorrhagy or tumours 
I have mentioned. But, confidering that the 
hemorrhagy occurring here, is often preceded 
' by pain, inflammation, and a febrile ftate, as 
well as by many other fymptoms which fiiow 
a connexion between the topical affedlionand 
the ftate of the whole fyftem, it feems proba- 
ble that the interruption of the venous blood, 
which we have fuppofedtotake place, operates 
in the manner explained in DCCLXIX ; and 
therefore, that the difcharge of blood here is 
a)mmonly from arteries. 




Some phyficians have been of opinion, thaC 
a difFerence in the nature of the hemorrhois, 
and of its effefts upon the fyftem, might a- 
rife from the difFerence of the hemorrhoidal 
vefFels from which the blood iffued. But it ap- 
pears to me, that hardly in any cafe we can dif- 
tinguifh the veffels from which the blood flows; 
and that the frequent inofculations of both 
the arteries and veins which belong to the 
lower extremity of the reftum, will render the 
elFefts of the hemorrhagy nearly the fame, 
from whichfoever of thefe vefTels the blood 


In DCCLXIX, I have endeavoured to ex- 
plain the mantier in which a certain Hate of 
the fanguiferous fyflem might give occafion 
to an hemorrhoidal flux ; and I have no doubt, 
that this flux may be produced in that man- 
ner. I cannot, however, by any means admit, 
that the difeafe is fo often produced in that 
manner, or that, on its firfl; appearance, it is 
fo frequently a fyfliematic afFeftion, as the 
Stahlians have imagined, and would have us 
to believe. It occurs in many perfons before 
the period of life at which the venous pletho- 
aa takes place ; it happens to females, in 
whom a venous plethora, determined to the 



hemorrhoidal veflTels, cannot be fuppofed ; and 
it happens to both fexes, and to pei fons of all 
ages, from c^ufes which do not afFe6l the fyf- 
tem, and are manifeflly fuited to produce a 
topical afFedtion only. 


Thefe caufes of a topicalafFe61;ionare,inths 
firft place, the frequent voiding of hard and 
bulky faeces, which, not only by their long 
flagnation in the reftum, but efpecially when 
voided, mufh prefs upon the veins of the anus,, 
and interrupt the courle of the blood in them. 
It is for this reafonthat the difeafe happens fo- 
often to perfons of a flow and bound belly. 


From the caufes jufl now mentioned, the 
diieale happens efpecially to perfons liable to 
fome degree of a prolapfus ani. Almofl eve- 
ry perlon in voiding faeces has the internal 
eoat of the re6lum more or lefs prolmded 
without the body ; and this- will be to a great- 
er or leffer degree, according as the hardnefs 
and bulk of the fasces occahon a greater or 
leffer effort or pieffure upon the anus. While 
the gut is thus pufhed out, it often happens, 
that the fphin6ler ani is, contKafted before the 
gut is replaced ; and, in confequence thereof,, 
a ftrong condritlion is made, which preventing, 
the fallen out gut from being replaced, and ai 

Vol. 2. K 5 the 

214 P R A CJT I C E 

the fame time preventing the return of blood 
from it, occafions its being confiderably fwell- 
cd, and its forming a tumid ring round the 


Upon the fphinfter's being a little relaxed, 
as it is immediately after its flrong contrac- 
tion, the fallen out portion of the gut is com- 
monly again taken within the body ; but, by 
the frequent repetition of fuch an accident, 
the fize and fullnefs of the ring formed by the 
fallen out gut, is much increaled. It is there- 
fore more flowly and difficultly replaced -and 
Mn this confifts the chief unealinefs of hemor- 
rhoidal perlons. 


As the internal edge of the ring mentioned, 
is necelfarily divided by clefts, the whole often 
affumes the appearance of a number of dif- 
tinftfwellings; and it alfo frequently happens, 
that fome portions of it, more confiderably 
fwellcd than others, become more protube- 
rant, and form thofe fmall tumours more 
flriftly called Hemorrhoids, or Piles. 


From confidering that the prefTure of fasces, 
and other caufes interrupting the return of 



venous blood from the lower extremity of the 
redum, may operate a good deal higher up in; 
the gut than that extremity, it may be eahly 
underftood that tumours may be formed 
within the anus ; and probably it alfo hap- 
pens, that fome of the tumours formed with-^ 
out the anus, as in DCCCCXXXIX, may 
continue when taken within the body, and 
even be increafed by the caufesjufl now men- 
tioned. It is thus that I would explain the 
produdion of internal piles, which, on account 
of their fituation and bulk, are not protruded 
on the perfon's going to flool, and are otten,, 
therefore, more painful. The fame internal 
piles are more efpecially painful, when af— 
i'c6ied by the hemorrhagic effort defcribed in^ 


The produ£lion of piles is particularly il-- 
luftrated by this, that pregnant women are 
frequently affeded with them. This is to 
be accounted for partly from the preffure of 
the uterus upon the reftum, and partly from 
the coftive habit to which pregnant women 
arc ufually liable.. I have known many in- 
llanccs of piles occurring for the firft time 
during the Hate of pregnancy ; and there are 
few women that have born children who are 
afterwards entirely free from piles. The 
Stahlians have commonly afierted, that the 
male fex is more frequently affeded with this 
K 6 difeafe. 


difeafe than the female ; but in this country I 
have conllantly found it otherwife. 


It is commonly fuppofed, that the frequent 
ule of purgatives, efpecially of thofe of the 
more acrid kind, and more particularly of al- 
oetics, is apt to produce the hemorrhoidal af- 
feftion ; and as thefe purgatives ftimulate 
chiefly the great guts, it feems fufficiently 
probable that they may excite this difeafe. 


I have now mentioned feveral caufes which 
may produce the hemorrhoidal tumours and 
flux as a topical aff^e6lion only ; but muft ob- 
ierve farther, that although the difeafe appears 
firft as a purely topical aff^eftion, it may, by 
trequent repetition, become habitual ; and 
therefore may become connc6tcd with the 
whole fyftem, in the manner already explain- 
ed, with refpeft to hemorrhagy in general, in 


The doftrine now referred to will, it is ap- 
prehended, apply very fully to the cafe of 
the hemorrhoidal flux ; and will the more 
readily apply, from the perfon who has been 
once afl'tdcd being much cxpofed to a re- 

O F P H Y S I C. 217 

newal of the caufes which firfl occafioned the 
difeafe ; and from many perfons being much 
expofed to a congeftion in the hemorrhoidal 
veifels, in confequence of their being often in 
an ereft pofition of the body, and in an exer- 
cife which pufhes the blood into the depend- 
ing veffels, while at the fame time the efFeds 
of thefe circumftances are much favoured by 
the abundance and laxity of the cellular tex- 
ture about the reftum. 


It is thus that the hemorrhoidal flux is fo 
often artificially rendered an habitual and fyf- 
tematic afi^eftion ; and I am perfuaded, that 
it is this which has given occafion to the 
Stahlians to confider the difeafe as almoll 
univerfally fuch. 


It is to be particularly obferved here, that 
when the hemorrhoidal difeafe has either been? 
originally, or has become, in the manner jull 
now explained, a fyftematic afFeftion, it then 
acquires a particular connexion with the 
ftomach, fo that certain affeftions there ex- 
cite the hemorrhoidal difeafe, and certain 
dates of the hemorrhoidal a ffeftion excite dif- 
orders of the ftomach. 



It is perhaps owing lo this connexion that 
the gout fometimes atFeds the re£lum. See 

T, II. 

Of the Cure of Hemorrhoidal Affec- 


ALMOST at all times it has been an opin- 
ion amongft phyficians, and from them Ipread 
amongfl the people, that the hemorrhoidal 
flux is a falutary evacuation which prevents 
many difeafes that would otherwife have hap- 
pened ; and that it even contributes to give 
long life. This opinion, in later times, has 
been efpecially maintained by Dr. Stahl and 
his followers ; and has had a great deal of in- 
fluence upon the praftice of phyfic in Ger- 


The queflion arifes with refpcft to hemor- 
rhagy in general, and indeed it has been ex- 
tended fo far by the Stahlians. I have ac- 
cordingly confidered it as a general queflion, 
(DCCLXVII— DCCLXXXji but it has 



been more efpecially agitated with regard to 
the difeafe now under our confi deration : 
And as to this, although I am clearly of opin- 
ion, that the hemorrhois may take place irj 
conlequence of the general flate of the fyftem 
(DCCLXIX j; or, what is flill more frequent, 
that by repetition it may become conne6led 
with that general ftate (DCCCCXLIII), and 
in either cafe cannot be fuppreffed without 
great caution ; I mud beg leave, notwithfland- 
ing this, to maintain, that the firft is a rare 
cafe, that generally the difeafe firft appears as 
an afFeaion purely topical (DCCCCXXXV, 
DCCCCXLII), and that the allowing it to 
become habitual is never proper. It is a nafty 
difagreeable difeafe, ready to go to excefs, 
and to be thereby very hurtful, as well as 
fometimes fatal. At beft it is liable to acci- 
dents, and thereby to unhappy coniequences. 
I am therefore of opinion, that not only the 
firft approaches of the difeafe are to be guard- 
ed againft ; but even that when it has taken 
place for fome time, from whatever caufe it 
may have proceeded, the flux is always to be 
moderated, and the neceflity of it, if poflible^ 


Having delivered thefe general rules, I 
proceed to mention more particularly, how 
the difeafe is to be treated, according to the 



different circumftances under which it may 

When we can manifeftly difcern the firft 
appearance of the difeafe to arife from caufes 
atling upon the part only, the ftrifteft atten- 
tion ihould be employed in guarding againfl 
the renewal of thefe caufes. 


One of the moft frequent of the remote 
caufes of the hemorrhoidal affeftion, is a flow 
and bound belly, (DCCCCXXXVI) : And 
this is to be conftantly obviated by a proper 
diet, which each individual's own experience 
n\ufl dire6i: ; or, if the management of diet be 
not effe6lual, the belly mufl be kept regular 
by fuch medicines as may prove gently laxa- 
tive, without irritating the re6lum. In moft 
cafes it will be of advantage to acquire a hab- 
it with refpeft to time, and to obfcrve it 


Another caufe of hemorrliois ta be efpec- 
ially attended to, is the prolapfus or protru- 
fion of the anus, which is apt to happen on a 
perfon's having a ftoo! (DCCCCXXX VII.) 
If it fliall occur to any confidcrable degree, 
and at the fame time be not eafiJy and imme- 
diately replaced, it moft certainly produces 
piles, or increafes them when othcrwife pro- 


uced Perfons therefore liable to this pro- 
ipfus' fhould, upon their having beenatftool, 
ake great pains to have the gut immediately 
eplaced, hy lying down in a horizontal po - 
Lire, and preffing gently upon the anus till 
he rcdudion fhall be completely obtained. 


When the prolapfus of which I fpeak is 
^ccafioned only by voiding hard and bulky 
^ajces, it Ihould be obviated by the means 
mentioned in DCCCCL, and may be thereby 
ivoided. But in fome perfons it is owing to 
1 laxity of the reftum ; in which cafe it is 
Dften moft confiderable upon occafion of a 
loofe ftool ; and then the difeafe is to be treat- 
ed by aftringents, as well as by proper arti- 
fices for preventing the falling down of the 


Thefe are the means to be employed upon 
the firft approaches of the hemorrhoidal af- 
fedion ; and when from negleft it fhall have 
frequently recurred, and has become in fome 
meafure eftablifhed, they are no lefs proper. 
In the latter cafe, however, fome other means 
are alfo neceffary. It is particularly proper 
to guard againft a plethoric ftate of the body ; 
confequently, to avoid a fedentary life, a full 
diet, and particularly intemperance in the ufe 




of ftrong liquor ; which, as I fhould have ob, 
ferved before, is, in all cafes of hemorrhagy^ 
of the greateft influence in increafing the dil- 
pofition to the difeafe. 


I need hardly repeat here, that excrcife of 
all kinds muft be a chief means of obviating 
and removing a plethoric ftate of the body j 
but upon occafion of ihe hemorrhoidal flux 
immediately approaching, both walking and 
ridincr, as increafing the determination of the 
blood into the hemorrhoidal veflels, are to 
be avoided. At other times, when no fuch 
determination has been already formed, thofe 
modes of exercife may be very properly em- 


Cold bathing is another remedy that may 
be employed to obviate plethora, and prevent 
hemorrhagy ; but it is to be ufed with cau- 
tion. When the hemorrhoidal flux is ap- 
proaching, it may be dangerous to turn it 
fuddenly afide by cold bathing : But during 
the intervals of the difeafe, this remedy may 
be employed with advantage ; and in perfons 
liable to a prolapfus ani, the frequent wafliing 
of the anus with cold water may be very 




Thefe are the means for preventing the re- 
currence of the hemorrhoidal flux ; and in all 
cafes, when it is not immediately approaching, 
they are to be employed. When it has actu- 
ally come on, means are to be employed for 
moderating it as much as pofllble, by the 
pcrfons lying in a horizontal pofition upon a 
hard bed ; by avoiding exercife in an ere6l 
pofture ; by ufing a cool diet ; by avoiding 
external heat ; and by obviating the irritation 
of hardened faeces by the ufe of proper laxa- 
tives, (DCCCCL). From what has been 
faid above, as to the being careful not to in- 
creafe the determination of the blood into the 
hemorrhoidal veffels, the propriety of thefe 
meafurcs mufl fufRciently appear ; and if they 
were not fo generally neglefted, many perfons 
would efcape the great trouble, and the va- 
rious bad confequcnces which fo frequently 
refuit from this difeafe., 


With refpeft to the further cure of this 
difeafe, it is almoft in two cafes only, that 
hemorrhoidal perfons call for the affiilince of 
the phyfician. The one is when the affec- 
tion is accompanied with much pain ; and of 
this there are two cafes, according as the pain 

h appens 


happens to attend the external or the inter- 
nal piles. 


The pain of the external piles arifcs efpec- 
ially when a confiderable protrufion of the 
re6lum has happened ; and when, continuing 
unreduced, it is flrangled by the conftriftion 
of the fphin61er ; while, at the fame time, no 
bleeding happens, to take off the fwelling of 
the protruded portion of the intcftine. Some- 
times an inflammation fupervenes, and greatly 
aggravates the pain. To relieve the pain in 
this cafe, emollient fomentations and poultices 
are fometimes of fervice ; but a more efFe£lual 
relief is to be obtained by applying leeches 
to the tumid parts. 


The other cafe in which hemorrhoidal per- 
fons feek afliftance, is that of exceffive bleed- 
ing. Upon the opinion fo generally received 
of this difcharge being falutary, and from the 
obfervation that upon the difcharge occurring 
perfons have fometimes found relief from va- 
rious diforders, the moft part of perfons liable 
to it are ready to let it go too far ; and indeed 
the Stahlians will not allow it to be a difeafe, 
unlefs when it has aftually gone to excefs. I 
am, however, well perfuaded, that this flux 
ought always to be cured as foon as poflible. 




When the difeafe occurs as a purely topical 
afFeftion, there can be no doubt of the pro- 
priety of this rule ; and, even when it has oc- 
curred as a critical difcharge in the cafe of a 
particular difeafe, yet when this difeafe fliall 
have been entirely cured and removed, the 
preventing any return of the hemorrhois feems 
to be both fafe and proper. 


It is only when the difeafe arifes from a 
plethoric ftate of the body, and from a flag- 
nation of blood in the hypochondriac region ; 
or when, though originally topical, the difeafe, 
by frequent repetition, has become habitual, 
and has thereby acquired a connexion with 
the whole fyftem, that any doubt can arife as to 
the fafety of curing it entirely. Even in thefe 
cafes, however, I apprehend it will be always 
proper to moderate the bleeding j left by its 
continuance or repetition, the plethoric ftate 
of the body, and the particular determination 
of the blood into the hemorrhoidal velfels, be 
increafed, and the recurrence of the difeafe, 
with all its inconveniences and danger, be too 
much favoured. 




Further, even in the cafes flated 
(DCCCCLXI), in fo far as the plethoric ftate 
of the body, and the tendency to that ftate, 
can be obviated and removed, this is always 
to be diligently attempted ; and if it can be 
executed with fuccefs, the flux may be entire- 
ly fuppreffed. 


The Stahlian opinion, that the hemorrhoi- 
dal flux is only in excefs when it occafions 
great debility, or a leucophlegmatia, is by no 
means juft ; and it appears to me, that the 
fmalleft approach towards producing either of 
thefe, fhould be confidered as an excefs, which 
ought to be prevented from going farther. 


In all cafes therefore of excefs, or of any 
approach tow^ards it, and particularly when 
the difeafe depends upon a prolapfus ani 
(DCCCCLI), lamof opinion that aftringents, 
both internal and external, may be fafely and 
properly employed ; not indeed to induce an 
immediate and total fuppreflion, but to mod- 
erate the hemorrhagy, and hy degrees to fup- 
prefs it altogether, while at the fame time 



meafures are taken for removing the neceffity 
of its recurrence. 


When the circumftances (DCCCCXLVI) 
marking a connexion between the hemorrhoi- 
dal affeftion and the ftate of the ftomach oc- 
cur, the meafures neceflary are the fame as in 
the cafe of atonic gout. 



"c H A P. VI. 




Blood difchargedfrom the 
vagina may proceed from different fources in 
the internal parts ; But I here mean to treat 
of thofe difcharges only, in which the blood 
may be pre fumed to flow from the fame fourc- 
es that the menfes in their natural ftate pro- 
ceed from ; and which difcharges alone, are 
thofe properly comprehended under the pref- 
ent title. The title of Metrorrhagia, or 
h^emorrhagia uteris might comprehend a great 
deal more. 


The menorrhagia may be confidered as of 
two kinds ; either as it happens to pregnant 
and lying in women, or as it happens to 
women neither pregnant nor having recently 
born children. The firfl kind, as connefted 



with the circumflances of pregnancy and 
childbearing, (which are not to be treated of 
in the prefent courfe), I am not to confider 
here, but fhall confine liiylelf to the lecond 
kind of menorrhagia only. 


The flow of the menfes is confidered as im- 
moderate, when it recurs more frequently, 
when it continues longer, or when, during the 
ordinary continuance, it is more abundant 
than is ufual with the fame perfon at other 


As the mofl part of women are liable to 
fome inequality with refpeft to the period, 
the duration, and the quantity of their menf- 
es ; fo it is not every inequality in thefe re- 
fpefts that is to be confidered as a difeafe ; 
but only thofe deviations, which are exceflive 
in degree, which are permanent, and which 
induce a manifeft ftate of debility. 


The circumRances (DCCCCLXVIII, 
DCCCCLXIX) are thofe which chiefly con- 
ftitutc the menorrhagia : But it is proper to 
obferve, that although I allow the frequency, 
duration, and quantity of the menfes to be 

Vol. II. L judged 


judged of by what is ufual with the fame in- 
dividual at other times ; yet there is, in thefe 
particulars, fo much uniform4ty obfervable in 
the whole of the fex, that in any individual 
in whom there occurs a confiderable devia- 
tion from the common meafure, fuch a devia- 
tion, if conftantly recurring, may be confider- 
ed as at Icaft approaching to a morbid ftate, 
and as requiring moflof the precautions which 
I fhall hereafter mention as neceflary to be 
attended to by thofe who are aftually in fuch 
a ftate. 


However we may determine with refped 
to the circumftances DCCCCLXVIII, 
DCCCCLXIX, it mufl ftill be allowed, that 
tlie immoderate flow of the menfes is efpecial- 
]y to be determined by thofe fymptoms af- 
fe6ling other funflions of the body, which ac- 
company and follow the difcharge. 

When a larger flow than ufual of the 
menfes has been preceded by headach, giddi- 
nefs, or dyfpnoea, and has been ulhered in by 
a cold ftage, and is attended with much pain 
of the back and loins, with a frequent pulfe, 
heat, and thirft, it may then be confidered as 
preternaturally large. 


When, in confequence of the circum- 


OF PHYSIC. -231 

and the repetition of tiiefe, the face becomes 
pale ; the pulfe grows weak ; an unufual 
debility is felt in exercife ; the breathing is 
hurried by moderate exercife ; when, alfo, the 
back becomes pained from any continuance 
in an ereft pofture ; when the extremities be- 
come frequently cold ; and when in the even- 
ing the feet appear affedted with oedematous 
fwelling ; we may from thefe fymptoms cer- 
tainly conclude, that the flow of the menfes 
has been immoderate, and has already induc- 
ed a dangerous ftate of debility. 


The debility thus induced, does often dif- 
cover itfelf alfo by afFeftions of the ftomach, 
^' as anorexia and other fymptoms of dyfpepfia ; 
by a palpitation of the heart, and frequent 
faintings ; by a weaknefs of mind liable to 
ftrong emotions from flight caufes, efpecially 
when fuddenly prefented. 


That flow of the menfes, which is attended 
with barrennefs in married women, may be 
j^enerally confidered as immoderate and mor- 




Generally, alfo, that flow of the menf- 
es may be confidered as immoderate, which 
is preceded and followed by a leucorrhcea. 


I treat of mcnorrhagia here as an a6live 
hemorrhagy, becaufe I confider menftruation, 
in its natural flatc, to be always of that kind ; 
and although there fhould be cafes of mcnor- 
rhagia which might be confidered as purely 
paffive, it appears to me that they cannot be 
?b properly treated of in any other place. 


has for its proximate caufe, either the hemor- 
rhagic effort of the uterine veffels preternatu- 
rally increafed, or a preternatural laxity of the 
extremities of the uterine arteries, the hemor- 
jrhagic effort remaining as in the natural ftate, 


The remote caufes of the menorrhagi* 
may be, iji, Thofe which increafe the plethor- 
ic ftate of the uterine veffels ; fuch as a full 
and nourifhing diet, much ftrong liquor, and 
frequent intoxication. 2t?/y, Thofe which 
determine the blood more copioufly and for- 


cibly into the uterine veffcls ; as violent ftrain- 
ings of the whole body ; violent (hocks of the 
whole body from falls ; violent ftrokes or cbn- 
tufions on the lower belly ; violent exercife, 
particularly in dancing ; and violent paflions 
of the mind, ^dly, Thofe which particularly 
irritate the veffels of the uterus ; as excefs in 
venery ; the exercife of venery in the time of 
menftruation ; a coftive habit, giving occafion 
to violent draining at ftool ; and cold applied 
to the feet, ^thly, Thofe which have forcibly 
overftrained the extremities of the uterine vef- 
fels ; as frequent abortions ; frequent chikl- 
bearing without nurfmg ; and difficult tedious 
labours. Or, lafilyy Thofe which induce a 
general laxity ; as living much in warm cham- 
bers, and drinking much of warm enervating 
liquors, fuch as tea and coffee. 


The ^ffeBiS of the menorrhagia are pointed 
where I have mentioned the feveral fymp- 
toms accompanying the difeafe, and from 
thefe theconlequences tobe apprehended will 
alfo readily appear. 


The treatment and cure of the menorrha- 
gia muft be different, according to the differ- 
ent caufes of the difeafe. 

L3 In 


In all cafes, the firft attention ought to be 
given to avoiding the remote caufes, whenever 
that can be done ; and by that means the dif- 
eafe may be often entirely avoided. 

When the remote caufes cannot be avoided, 
or when the avoiding them has been negle£l- 
cd, and therefore a copious menftruation has 
come on, it fhould be moderated as much as 
poflible, by abftaining from all exercife, either 
at the coming on or during the continuance of 
the menftruation ; by avoiding even an erefl; 
pollure as much as poflTible ; by Ihunning 
external heat, and therefore warm chambers 
and foft beds j by ufmg a light and cool diet ; 
by taking cold drink, at leaft as far as former 
habits will allow ; by avoiding venery ; by 
obviating coftivenefs, or removing it by laxa- 
tives that give little flimulus. 

The fex are commonly negligent, either in 
avoiding the remote caufes or in moderating 
the firft beginnings of this difeafe. It is by 
fuch neglea that it fo frequently becomes vi- 
olent, and of difficult cure ; and the frequent 
repetition of a copious menftruation, may be 
confidered as a caufc of great laxity itithe ex- 
treme veHels of the uterus. 


When the coming on of the menftruation 
has been preceded by fome diforder in other 
parts of the body, and is accompanied with 
pains of the back, refembhng parturient pains, 



together with febrile fymptoms, and when at 
the fame time the flow feems to be copious, 
then a bleeding at the arm may be proper, 
but it is not often necelfary ; and it will in 
mo ft cafes be fufficient to employ, with great 
attention and diligence, thofc means for mod- 
crating the difcharge which have been men- 
tioned in the lad paragraph. 


When the immoderate flow of the menfes 
(hall feem to be owing to a laxity of the velfels 
of the uterus, as may be concluded from the 
general debility and laxity of the perfon's 
habit ; from the remote caufes that have occa- 
fioned the difeafe (DCCCCLXXVIII) ; 
from the abfence of the fymptoms which de- 
note increafed aftion in the veflels of the ute- 
rus (DCCCCLXXI) ; from the frequent re- 
currence of the difeafe ; and particularly from 
this, that in the intervals of menftruation the 
perion is liable to a leucorrhoca ; then in fuch 
cafe the difeafe is to be treated, not only by 
employing all the means mentioned in 
DCCCCLXXX, for moderating the hemor- 
rhagy, but alfo by avoiding all irritation, eve- 
ry irritation having the greater effeft in pro- 
portion as the veflels have been more lax and 
yielding. If, in fuch a cafe of laxity, it fhall 
appear that fome degree of irritation concurs^ 
opiates may be employed to moderate the dif- 
L 4 charge ; 


charge ; but in ufing thefe, much caution is 

If, notwithflanding thcfe meafures having 
been taken, the difchaige fhall prove very 
large, aftringents both external and internal 
may be employed. In fuch cafes, may fmall 
dofes of emetics be of fervice ? 


When the menorrhagia depends on the lax- 
ity of the uterine veffels, it will be proper, in 
the intervals of menftruation, to employ tonic 
remedies ; as cold bathing and chalybeates. 
The exercifes of geflation, alfo, may be very 
ufeful, both for ftrengthening the whole fyf- 
tem, and for taking off the determination of 
the blood to the internal parts. 


The remedies mentioned in thefe two lafl: 
paragraphs, may be employed in all cafes of 
menorrhagia, from whatever caufe it may 
have proceeded, if the difeafe fhall have al- 
ready induced a confiderable degree of debil- 
ity in the body. 


O F P H Y S IC. 237 

CHAP. Vll. 



Every ferous or puriform 
difcharge from the vagina, may be, and has 
been comprehended under one or other of the 
appellations I have prefixed to this chapter. 
Such difcharges, however, may be various ; 
and may proceed from various fources, not 
yet well alcertained ; but I confine mylelf here 
to treat of that difcharge alone which may be 
prefumed to proceed from the fame veffels, 
which, in their natural ftate, pour out the- 


I conclude a difcharge from the vagina to 
be of this kind ; 1. From its happening to 
women who are fubjea to an immoderate 
flow of the menfes, and liable to this from 

Vol.2, L5 '^^^^^ 


caufes weakening the veflels of the uterus. 
2. From its appearing chiefly, and often only, 
a little before, as well as immediately after, the 
flow of the menfes. 3. From the flow of the 
menfes being diminiftied, in proportion as the 
leucorrhoea is increafed. 4. From the leu- 
corrhoca continuing after the menfes have en- 
tirely ceafed, and with fome appearance of its 
obferving a periodical recurrence. 5. From 
the leucorrhoea being accompanied with the 
effeas of the menorrhagia (DCCCCLXXII, 
DCCCCLXXIII.) 6. From the difcharge 
having been neither preceded by, nor accom- 
panied with, fymptoms of any topical aflFec- 
tions of the uterus. 7. From the leucorrhoea 
not having appeared foon after communica- 
tion with a perfon who might be fufpefted of 
communicating infedion, and from the firft 
appearance of the difeafe not being accom- 
panied with any inflammatory aflFeftion of the 


The appearance of the matter difcharged 
in the leucorrhoea, is very various with re- 
fpeft to conliftence and colour ; but from 
thefe appearances, it is not always poffible to 
determine concerning its nature, or the partic- 
ular fource from whence it proceeds. 




The leucorrhoea, of which I am to treat, as- 
afcertained by the feveral circum (lances 
(DCCCCLXXXVI) fcems to proceed fjom 
the fame caufes as that fpecies of menorrha- 
gia which I fuppofc to arife from the laxity 
of the extreme velfels of the uterus. It ac- 
cordingly often follows or accompanies fuch 
a menorrhagia ; but though the leucorrhcea 
depends chiefly upon the laxity mentioned, 
it may have proceeded from irritations induc- 
ing that laxity, and feems to be always in.- 
creafed by any irritations applied to the 


Some authors have alleged, that a variety 
of circumflances in other parts of the body 
may have a fhare in bringing on and in con- 
tinuing this affe6lionof the uterus now under 
confideration ; but I cannot difcover the real- 
ity of thofe caufes ; and it feems to mc, that; 
this leucorrhoea, excepting in fo far as it de- 
pends upon a general debility of the fyilem, is 
always primarily an affedion of the uterus ; 
and the affedions of other parts of the body 
which may happen to accompany it, are for 
the moft part to be confidered as effefts, rath- 
er than as caufes. 




The efFedsof the Icucorrhoea are much the 
f,5ime with thofe of menorrhagia ; inducing a 
general debility, and in particular, a debihty 
in the fundions of the flomach. If, however, 
the leucorrhcea be moderate, and be not ac- 
companied with any confiderable degree of 
menonhagia, it may often continue long 
without inducing any great degree of debility, 
and it is only when the difcharge has been 
very copious as well as conftant, that its efFefts 
in that way are very remarkable. 


But, even when its efFefts upon the whole 
body are not very confiderable, it may ftill be 
fuppofed to weaken the genital fyftem ; and it 
feems fufficiently probable that this difcharge 
may often have a Ihare in occafioning barren- 


The matter difcharged in the leucorrhcea, 
is at firfl generally mild ; but after fome con^ 
tinuance of the difeafe, it fometimes becomes 
acrid ; and by irritating, or perhaps eroding, 
the furfaces over which itpaifes, induces vari- 
ous painful diforders. 




As I have fuppofed that the leucorrhoea 
proceeds from the fame caufes as that fpecie^ 
of menorrhagia which is chiefly owing to a 
laxity of the uterine vefTels, it mull be treated, 
and the cure attempted, by the fame means 
as deHvered in DCCCCLXXXII, for the 
cure of menorrhagia, and with lefs referve in 
refpeO; of the ufe of aftringents. 


As the leucorrhoea generally depends upon 
a great lofs of tone in the veflels of the uterus, 
the difeafe has been relieved, and fometimes 
cured by certain ftimulant medicines, which 
are commonly determined to the urinary paf- 
fages, and from the vicinity of thefe are often 
communicated to the uterus. Such, for ex- 
ample, are cantharides, turpentine, and other 
balCams of a fimilar nature. 






Whatever, in a fyftem 

of methodical nofology, may be the fittcft 
place for the amenorrhoea, it cannot be im*- 
proper to treat of it here as an objeft of prac- 
tice, immediately after having confidered the 


The interruption of the menftrual flux is to- 
be confidered as of two different kinds ; the 
one being when the menfes do not begin to 
flow at that period of life at which they ufual- 
ly appear ; and the other being that when, af- 
ter they have repeatedly taken place for fome 
time, they do, from other caufes than concep- 
tion, ceafe to return at their ufual periods : 


O F P H Y S I C. 243 

The former of thefe cafes is named the retention, 
and the latter the fupprejfion^ of the menfes. 


As the flowing of the menfes depends upon 
the force of the uterine arteries impelling the 
blood into their extremities, and opening 
thefe fo as to pour out red blood j fo the in- 
terruption of the menftrual flux muft; depend, 
either upon the want of due force in the aftion 
of the uterine arteries, or upon fome preter- 
natural refiftance in their extremities. The 
former I fuppofe to be the mofl; ufual caufe 
of retention, the latter the mofl: common caufe 
of fuppreflion ; and of each of thefe I fliall 
now treat more particularly. 


The retention of the menfes, the emanjio 
menjium of Latin writers, is not to be confid- 
ered as a difeafe merely from the menfes not 
flowing at that period which is ufual with 
moft other women. This period is fo differ- 
ent in different women, that no time can be 
precifely afligned as proper to the fex in gen- 
eral. In this climate, the menfes ufually ap- 
pear about the age of fourteen ; but in many 
they appear more early, and in many not till 
the fixteenth year ; in which laft cafe it is oft- 
en without any diforder being thereby occa- 
fioned. It is not therefore from the age of 



the perfon, that the retention is to be confid- 
ered as a difeafe ; and it is only to be confider- 
cd as fuch, when, about the time the menfes 
ufually appear, fome difordei^s arife in other 
parts of the body which may be imputed to 
their retention ; being fuch as, when arifmg 
at this period, are known from experience to 
be removed by the flowing of the menfes. 


Thefe diforders are, a fluggifbnefs and fre- 
C|uent fenfe of lallitude and debihty, with va- 
rious fymptoms of dyfpepfia ; and fometimcs 
with a preternatural appetite. At the fame 
time the face lofes its vivid colour, becomes 
pale, and fometimes of a yellowilh hue j the 
whole body becomes pale and flaccid ; and 
the feet, and perhaps alfo a great part of the 
body, become aff"e6i:ed with cedematous fwell- 
ing. The breathing is hurried by any quick 
or laborious motion of the body, and the heart 
is liable to palpitation and fyncope. A hcad- 
ach fometimes occurs j but more certainly 
pains of the back, loins, and haunche*. 


Thefe fymptoms, when occurring in a high 
degree, confl:itute the chlorofis of authors, hard- 
ly ev^r appearing feparate from the retention 
of the menfes ; and, attending to thefe fymp- 


toms, the caufe of this retention may, I think, 
be perceived. 

Thefe fymptoms manifeflly fhow a confid- 
erable laxity and flaccidity of the whole fyf- 
tem ; and therefore give reafon to conclude, 
that the retention of the menfes accompany- 
ing them, is owing to a weaker a6lion of the 
velfels of the uterus ; which therefore do not 
impel the blood into their extremities with a 
force fufficient to open thefe, and pour out 
blood by them. 


How it happens that at a certain period of 
life a flaccidity of the fyflem arifes in young 
women not originally affefted with any fuch 
weaknefs or laxity, and of which, but a little 
time before, they had given no indication, 
may be difficult to explain ; but I would at- 
tempt it in this way. 

As a certain ftate of the ovaria in females, 
prepares and difpofes them to the exercife of 
venery, about the very period at which the 
menfes firft appear, it is to be prefumed that 
the flate of the ovaria and that of the uterine 
veffels are in fome meafure conne6led togeth- 
er ; and as generally fymptoms of a change in 
the ftate of the former appear before thole of 
the latter, it may be inferred, that the ftate of 
the ovaria has a great ftiare in exciting the ac- 
tion of the uterine veffels, and producing the 
menftrual flux. But, analogous to what hap- 


pens in the male fex, it may be prclunied, 
that in females a certain ftatc of the genitals is 
neceffary to give tone and tenfion to the 
whole fyllem ; and therefore that, if the Aim- 
ulus arifmg from the genitals be wanting, the 
whole fyflem may fall into a torpid and flac- 
cid ftate, and from thence the chlorofis and 
retention of the menfes may arife. 


It appears to me, therefore, that the reten- 
tion of the menfes is to be referred to a certain 
Hate or afFeftion of the ovaria : But what is 
precifely the nature of this alFeftion, or what 
are the caufes of it, I will not pretend to ex- 
plain ; nor can I explain in what manner that 
primary caufe of retention is to be removed. 
In this, therefore, as in many other cafes, 
where we cannot affign the proximate caufe of 
difeafes, our indications of cure mufl be form- 
ed for obviating and removing the morbid ef- 
fefts or fymptoms which appear. 


The efFefls, as has been faid in M, confill 
in a general flaccidity of the fyflem, and con- 
fequently in a weaker a6lion of the veffels of 
the uterus ; fo that this debility may be con- 
fidered as the more immediate caufe of the re- 
tention. This, therefore, is to be cured by 
reftoring the tone of the fyllem in general, 



and by exciting the aftion of the uterine vef- 
{els in particular. 


The tone of the fyflem in general is to be 
reflored by exercife, and, in the beginning 
of the difeafe, by cold bathing. At the fame 
time, tonic medicines may be employed ; and 
of thefe the chalybeates have been chiefly rec- 


The a61;ion of the veflels of the uterus may 
be excited : 

ifl. By determining the blood into them 
more copioufly ; which is to be done by de- 
termining the blood into the defcending aor- 
ta, by purging, by the exercife of walking, by 
fri6lion, and by warm bathing of the lower 
extremities. It is alfo probable that the blood 
may be determined more copioufly into the 
hypogaft;ric arteries which go to the uterus, by 
a compreflTion of the iliacs ; but the trials of 
this kind hitherto made have feldom fuc- 


2dly, The aftion of the uterine veflels may 
be excited by ftimulants applied to them. 
Thus thofe purgatives which particularly 
ilimulate the inteftinum reftum, may alfo 



prove ftimulant to the uterine veffels con- 
ne6led with thofe of the reftum. The exer- 
cife of venery certainly proves a flimulus to 
the veffels of the uterus ; and therefore may 
be ufeful when, with propriety, it can be em- 
ployed. The various medicines recommend- 
ed as flimulants of the uterine veffels, under 
the title of Emmenagogues, have never ap- 
peared to me to be effectual ; and I cannot 
perceive that any of them are poffeffed of a 
fpecific power in this refpeft. Mercury, as 
ah univerfal ftimulant, may a6l upon the ute- 
rus, but cannot be very fafely employed in 
chlorotic perfons. One of the mofl powerful 
means of exciting the aftion of the veffels in 
every part of the fyftem is, the ele6lrical fhock ; 
and it has often been employed with fuccefs 
for exciting the veffels of the uterus. 


The remedies (Mill — MVI) now men- 
tioned, are thofe adapted to the retention of 
the menfes ; and I am next to confider the 
cafe oi Jupprejfion, In entering upon this, I 
muft obferve, that every interruption of the 
flux, after it has once taken place, is not to be 
confidered as a cafe of fuppreffion. For the 
flux, upon its firfl appearance, is not always 
immediately eftablifhed in its regular courfe ; 
and therefore, if an interruption happen foon 
after the firft appearance, or even in the courfe 
of the firft, or perhaps fecond year after, it 


O F P H Y S I C. H9 

may often be confidered as a cafe of retention, 
efpecially when the difeafe appears with the 
fymptoms peculiar to that ftate. 


Thofe which may be properly confidered 
^s cafes of fuppreffion, are fuch as occur after 
the flux has been for fome time eftabliftied in 
its regular courfe, and in which the interrup- 
tion cannot be referred to the caufes of re- 
tention (Mil, Mill) but muftbe imputed to 
fome refiftance in the extremities of the vef- 
fels of the uterus. Accordingly, we often 
find the fuppreffion induced by cold, fear, and 
other caufes which may produce a conftric- 
tion of thefe extreme veffels. Some phyfi- 
cians have fuppofed an obftru6ling lentor of 
the fluids to occafion the refifl;ance now men- 
tioned : But this is purely hypothetical, with- 
out any proper evidence of the fa6l ; and it is 
befides, from other confiderations, improba- 


There are indeed fome cafes of fuppreffion 
that feem to depend upon a general debility 
of the fyllem, and confequently of the vefl'els 
of the uterus. But in fuch cafes, the fuppref- 
fion always appears as fymptomatic of other 
afl'eaions, and is therefore not to be confider- 
ed here. 




The idiopathic cafes of fupprcfTion (M V III) 
feldom continue long without being attended 
with various fymptoms or diforders in differ- 
ent parts of the body ; very commonly arif- 
ing from the blood which fhould have paffed 
by the uterus, being determined morecopiouf- 
ly into other parts, and very often with fuch 
force as to produce hemorrhagies in theie. , 
Hence hemorrhagies from the nofe, lungs, 
flomach, and other parts, have appeared in 
confequence of fupprelTed menfes. Bcfides 
thefe, there are commonly hyfteric and dyf- 
peptic fymptoms produced by the fame caufe j 
and frequently colic pains, with a bound 


In the idiopathic cafes of fuppreflion, 
(MVIII) the indication of cure is to remove 
the conftri6lion affe6ling the extreme veffels 
of the uterus ; and for this puipofe the chief 
remedy is warm bathing applied to the region 
of the uterus. This, however, is not always 
effe6i:ual, and I do not know of any other 
remedy adapted to the indication. Befides 
this, we have perhaps no other means of re- 
moving the conftriftion in fault, but that of 
increafmg the a6lion and force of the veffels 
of the uterus, fo as thereby to overcome the 



refiftance or conftriftion of their extremities. 
This therefore is to be attempted by the fame 
remedies in the cafe of fupprefiion, as thofe 
prefcribed in the cafes of retention (MIV — 
MVI). The tonics, however, and cold bath- 
ing (MIV) feem to be lefs properly adapted 
to the cafes of fupprefiion, and have appeared 
to me of ambiguous efFeft. 


It commonly happens in the cafes of fup- 
prefiion, that though the menfes do not flow 
at their ufual periods, there are often at thofe 
periods fome marks of an effort having a ten- 
dency to produce the difcharge. It is there- 
fore at thofe times efpecially when the efforts 
of the fyflem are concurring, that we ought to 
employ the remedies for curing a fupprefiion ; 
and it is commonly fruitlefs to employ them 
at other times, unlefs they be fuch as require 
fome continuance in their ufe to produce 
their effeds. 



Nearly fimilar to the cafes of fupprefiion, 
arc thofe cafes in which the menfes flow after 
longer intervals and in lelfer quantity than u- 
fual ; and when thcfe cafes are attended with 
the diforders in the fyftem (MX) they are to 
be cured by the fame remedies as the cafes of 
entire fupprcfTion. 




It may be proper in this place to take no- 
tice of the dyfmenorrhea, or cafes of menflru- 
ation in which the menfes feem to flow with 
difficulty, and are accompanied with much 
pain in the back, loins, and lower belly. We 
impute this diforder partly to fome weaker 
aftion of the veffels of the uterus, and partly, 
perhaps more efpecially, to a fpafm of its ex- 
treme veffels. We have commonly found 
the difeafe relieved by employing fome of the 
remedies of fuppreffion immediately before 
the approach of the period, and at the fame 
time employing opiates. 


O £• PHYSIC. 253 




1 HxWE thought it very im- 
proper in this work, to treat of thole morbid 
afFeftions that are almoft always fymptomatic 
of other more primary difeafes ; and this for fev- 
cral reafons, particularly becaufe it introduces a 
great deal of confufion in directing praftice, 
and leads phyficians to employ palliative 
meafures only. I fliall here, howoKr, devi- 
ate a little from my general plan, lo make 
lome refleftions upon fymptomatic hemor- 


Thehemorrhagies of this kind that efpecia.- 
ly deferve our notice, are the Hematemefis, oi 
Vomiting of Blood j and the Hematuria, oi 
the Voidmg of Blood from the urinary paf. 
fagc. Upon thefe I am here to make fome re- 

VoL. II. M marks; 


marks ; becaufe, though they are very gener- 
ally fymptomatic, it is poflible they may he 
fometimes primary and idiopathic affcftions ; 
and becaufe they have been treated of as pri- 
mary difeafes in almofl every fyftem of the 
pradice of phyfic. 


Of the Hematemesis, or Vomiting of 


I HAVE faid above (in DCCCCXLVjin 
•what manner blood thrown out from the 
mouth may be known to proceed from the 
ftomach, and not from the lungs ; but it may 
be proper here to fay tnore particularly, that 
this may be certainly known, when the 
blood is brought up manifeftly by vomiting 
without any coughing ; when this vomiting 
has been preceded bv fome fenfe of weight, 
anxiety, and pain, in the region of the ftomach ; 
when the blood brought up is of a black and 
grumous appearance, and when it is manifeft- 
ly mixed with other contents of the ftomach ; 
we can feldom have any doubt of the fource 
from whence the blood proceeds, and there- 
fore of the exiftence of the difeafe we treat of. 




We mud allow it to be pofTiblc that a 
-plethoric Itate of the body from general caufes 
may be accompanied with caufes of a peculiar 
determination and afflux of blood to the 
llomach. fo as to occafion an hemorrhagy 
there, and thence a vomiting of blood j and 
in fuch a cafe this appearance might be con- 
fidered as a primary difeafe. But the hiftory 
of difeafes in the records of phyfic, afford lit- 
*tle foundation for fuch a fuppofition ; and on 
the contrary, the whole of the inflances of a 
vomiting of blood which have been recorded, 
are pretty manifeftly fymptomatic of a more 
primary afiFeftion. 

Of fuch fymptomatic vomitings of blood, 
the chief inllances are the following. 


One of the moft frequent is that which ap- 
pears in confcquence of a fuppreflion of an e- 
vacuation of blood which had been for fome 
time before eftablifhed in another part of the 
body, particularly that of the menllrual flux 
■in women. 


There aie inftances of a vomiting of blood 

happening from the retention of the menfes : 

M 2 But 


But fuch inftances are very uncommon ; as a 
retention of the menfes rarely happens in con- 
iequence of, or even with, a plethoric flate of 
the body ; and as rarely does it produce that, 
or the hewjorrhagy in quellion. 

There are inftances of a vomiting of blood 
happening to pregnant women ; that might 
therefore alfo be imputed to the fupprefTion 
of the menfes, which happens to women in 
that ftate. There have indeed been more in- 
ftances of this than of the former cafe ; but 
the latter are ft ill very rare ; for although the 
blood which ufed to flow monthly before im- 
pregnation, is, upon this taking place, retain- 
ed, it is commonly fo entirely employed in 
dilating the uterine veffels, and in the growth 
of the foetus, that it is feldom found to pro- 
duce a plethoric ftate of the body, requiring 
a vicarious outlet. 

The vomiting of blood, therefore, that is 
vicarious of the menftrual flux, is that which 
commonly and almoft only happens upon a 
fuppreffion of that flux, after it had been for 
fome time eftabliflied. 


When fuch a fuppreffion happens, it may 
be fuppofed to operate by inducing a plethor- 
ic ftate of the whole body, and thereby occa- 
fioning hemorrhagy from other parts of it j 
and hemorrhagies from, many different parts 
of the body have been obferved by phyficiajis 



as occurring in confequence of the fuppreffion 
we fpeak of. It is however the great variety 
of fuch hemorrhagies, that leads me to think, 
that with the plethoric ftate of thewhoie body 
there muft be always fome peculiar circum- 
ftances in the part from which the blood flows, 
that determines its afflux to that particular, 
often fingularly odd, part ; and therefore, that 
fuch hemorrhagies may from thefe circum- 
ftances occur without any confiderable pleth- 
ora at the fame time prevailing in the whole 


It is to be obferved, that if we are to expert 
an hemorrhagy in confequence of a fuppre(- 
fion of the menfes inducing a plethoric ftate 
of the fyftem, we ftiould exped efpecially an 
hemoptyfis, or hemorrhagy from the lungs, 
as a plethora might be experted to fliow its ef- 
fefts efpecially there ; and accordingly, upon 
occafion of fuppreffed menfes, that hemorrha- 
gy occurs more frequently than any other : 
But even this, when it does happen, neither 
in its circumftances nor its confequences, leads 
us to fuppofe, that at the fame time any con- 
fiderable or dangerous plethora prevails in the 


Thefe confideratlons in M XXI, MXXII, 

will, I apprehend, apply to our prefent fub- 

M 3 ject ; 


je6l J and I would therefore allege, that a 
hematemelis may perhaps depend upon par- 
ticular circumftances ot the flomach deter- 
mining an afflux of blood to that organ, and 
may therefore occur without any confiderabie 
or dangerous plethora prevailing in the fyf- 
tcm. What are the circumftances of the 
flomach, which, upon the occafion mentioned, 
may determine an afflux of blood to it, I can- 
not certainly or clearly explain ; but prefume 
that it depends upon the connexion and cort- 
fent which we know to fubfift between the u- 
terus and the whole of the alimentary canal, 
and efpecially that principal part of it the 


From thefe refle6tions, we may, I think, 
draw the following conclufions. 

I. That the hematemefis we fpeak of is 
hardly ever a dangerous difeafe. 

II. That it will hardly ever require the 
remedies fuited to the cure of aftive hemor- 
rhagy ; and at lead that it will require thefe 
only in thofe unufual cafes in which there ap- 
pear ftrong marks of a general plethora, and 
in which the vomiting of blood appears to be 
confiderably a£live, very profufe, and fre- 
quently recurring. 

III. That a vomiting of blood from fup- 
preffed menfes, ought feldom to prevent the 
uie of thefe remedies of amenorrhoea, which 


O F P H Y S I a ?59 

might be improper in the cafe of an a6live id- 
iopathic hemorrhagy. 


Another cafe of fymptomatic hematemefis 
quite analogous to that ah'eady mentioned, is 
the hematemefis following, and feemingly 
depending upon, the fuppreffionof an hemor- 
rhoidal flux, which had been eftablifhed and 
frequent for fome time before. 

This may perhaps be explained by a gen- 
eral plethoric ftate induced by fuch a fup- 
prelfion ; and indeed fome degree of a ple- 
thoric ftate muft in fuch a cafe be fuppofed to 
take place ; but that fuppofition alone will 
not explain the whole of the cafe ; for a gen- 
eral plethora would lead us to expeft an he- 
moptyfis(MXXII)rather than an hemateme- 
fis ; and there is therefore fomething ftill 
wanting, as in the former cafe, to explain the 
particular determination to the ftomach. 

Whether fuch an explanation can be got 
from the connexion between the different parts 
of the fanguiferous vefiels of the alimentary 
canal, or from the connexion of the whole of 
thefe veflels with the vena portarum, I fhall 
not venture to determine. But in the mean 
time I imagine, that the explanation required 
is rather to be obtained from that connexion 
of the ftomach with the hemorrhoidal affeftion 
that Ihavetakennoticeof inDCCCCXLVI. 




However we may explain the hematemefis 
occafioned by a fupprefTion of the hemonhois, 
the confiderations in MX XI, MXXII, will 
apply here as in the analogous cafe of hemat- 
emefis from fuppreffed menfes ; and will 
therefore allow us alfo to conclude here, that 
the difeafe we now treat of will feldom be 
daiigerous, and will feldom require the fame 
remedies that idiopathic and a6live hemorrha- 
gy does. 


The cafes of hematemefis already mention- 
ed, may be properly fuppofed to be hemor- 
rhagies of the arterial kind ; but it is probable 
that the ftomach is alfo liable to hemorrhagica 
of the venous kind. (DCCLXVIIIj. 

In the records of phyfic there are many in- 
flances of vomitings of blood, which were ac- 
companied with a tumefied fpleen, which had 
comprefTed the vas brev£, and thereby pre- 
vented the free return of venous blood from 
the ftomach. How fuch an interruption of 
the venous blood may occafion an hemorrha- 
gy from either the extremities of the veins 
themfelves, or from the extremities of their cor- 
refpondent arteries, we have explained above 
in DCCLXIX, and the hiftories of tumefied 
fpleens comprefling the vafa brevia, afford an 




excellent illuftration and confirmation of our 
doarine on that fubjeft, and render it fut- 
ficiently probable that vomitings of blood 
often arife from fuch a caufe. 


It is alfo poflible, that an obflruaion of the 
liver refilling the free motion of the blood m 
the vena portarum, may Ibmetimes interrupt 
the free return of the venous blood from the 
veffels of the ftomach, and thereby occafion a 
vomiting of blood ; but the inftances of this 
are neither fo frequent nor fo clearly explain- 
ed as thofe of; the former cafe. 


Befide thefe cafes depending on the flate oi 
the liver or fpleen, it is very probable that 
other hemorrhagies of the ftomach are fre- 
<iuently of the venous kind. 

The difeafe named by Sauvages Melac^na, 
and by other writers commonly termed the 
Morbus Niger (DCCLXXH), confiftmg in 
an evacuation either by vomiting or by flool, 
and fometimes in both ways, of .a black and 
grumous blood, can hardly be ctherwile oc- 
cafioncd, than by a venous hemorrhagy from, 
(ome part of the internal furface of the ali- 
mentary canal. 

It is, indeed, poffible, that the bile may 
fometimes put on a black and vifcid appear- 
VoL. 2. M 5 ^nce,^ 


a nee, and give a real foundation for the appel- 
lation of an Atra Bilis : But it is certain, that 
inllances of this are very rare ; and it is high- 
ly probable, that what gave occafion to the 
n,otion of an atra bilis among the ancients, was 
truly the appearance of blood poured into the 
alimentary canal in the manner I have men^ 
tioned ; and which appearance, we know, the 
blood always puts on when it has ftagnated 
there for any length of time. I fuppofe it is 
now generally thought, that Boerhaave's no^ 
tion of fuch a matter exifting in the mafs of 
blood, is without any foundation ; whilft, by 
diffe6lions in modern times, it appears very 
clearly, that the morbus nigcr prefenting fuch 
an appearance of blood, always depends upon 
the effufion and ftagnation I have mentioned. 


From this account of the melaena it will 
appear, that vomitings of blood may arife in 
confequence of blood being poured out in the 
manner I have mentioned, either into the cav- 
ity of the ftomach itfelf, or into the fuperior 
portions of the inteflines, from whence mat- 
ters often pafs into the ftomach. 


Both in the cafe of the malasna, and in the 
analogous cafes from affeftions of the fpleen or 
liver, it will appear, that the vomitings of 



blood occurring mufl be confidered as fymp- 
tomatic affediojns, not at all to be treated as a 
primary a^ive hemorrhagy, but by remedies, 
ifanyfuch be known, that may refolve the. 
primary obflru6lions. 


I believe I have now mentioned almofl the 
whole of the caufes producing an hematemeiis ; 
and certainly the caufes mentioned, are thofe 
which moll commonly give occafion to that 
fymptom. Pofhbly, however, there may be 
lome other caufes of it, fuch as that lingular 
one mentioned by Sauvage of an aneurifm of 
the aorta burfting into the floraach ; and it is 
poflible, that fome difeafes of other contiguous 
parts, which have become clofely adhering to 
the flomach, may fometimes, by a rupture irv,- 
to the cavity of the ftomach, pour blood into 
It, w:hich is afterwards reje6led by vomiting. 
It is polTible alfo, that abfceffes and ulcera- 
tions of the flomach itfelf, may fometimes 
pour blood into its cavity to be thrown up by 

I 4id not think it neceflary, among the 
fymptomatic vomitings of blood, to enumerate 
thofe from external violence, nor, what is an- 
alogous to it, that which arifes from violent 
ft raining to vomit ; which laft, however, is 
much more rare than misfht be exoefted. In 
either of thefe cafes the nature of the difeafe 
cannot be doubtful, and the management of it 
M 6 will 


wjli be readily underfloodfrom what has been 
dtlivcred above with lefpeft to moderating 
and rcftraining hemorrhagy in general. 

T. II. 

Oj the. Hematuria, or the Voiding of 
BiooD from the Urinary Passage. 


IT is alleged, that an hematuria has occur- 
red without any other fymptom of an affec- 
tion of the kidneys or urinary paffages being 
prcfent at the fame time ; and as this happen- 
ed to plethoric perfons, and recurred at fixed 
periods, fuch a cafe has been fuppofed to be 
an in (lance of idiopathic hematuria, and of the. 
nature of thofe a£live hemorrhagies I have 
treated of before. 


I cannot pofitively deny the exiflence of 
fuch a cafe ; but mufl obfei-ve, that there are 
very few inflances of fuch upon the records 
of phyfic ; that none have ever occurred to 
my obfervation, or to that of my friends ; and 
that the obfervations adduced may be falla- 
cious, as I have frequently obferved an hema- 


turia without fymptoms of other afFeQion of 
the kidney or urinary paffages being, for the 
time, prefent ; whilft,'however, fits of a neph- 
ralgia calculofa having, before or foon after, 
happened, rendered it to me fufficiently prob- 
able, that the hematuria was owing to a wound 
made by a (lone prefent in fome part of the 
urinary paffages. 


The exiflence of an idiopathic hematuria 
is further improbable, as a general plethora is 
more likely to produce an hemoptyfis 
(MX XI I), and as we do not well know of 
any . circumflances which might determine 
more particularly to the kidneys. An idio- 
pathic hematuria, therefore, muft certainly be 
a rare occurrence ; and inflances of fympto- 
matic afFedions of the fame kind are very 


One of the mofl frequent is, that hematuria 
which attends the nephralgia calculofa, and 
feems manifeftly to be owing to a ftone 
wounding the internal furface of the pelvis of 
the kidney or of the ureter. In fuch cafes, 
the blood difcharged with the urine is fome- 
times of a pretty florid colour, but for the 
mod part is of a dark hue ; the whole of it is 
fometimes diffufed or diflTolved, and therefore 



entirely fufpended in the urine ; but if it is in 
any large quantity, a portion of it is depofited 
to the bottom of the velTel containing the 
voided blood and urine. On different occa- 
lions the blood voided puts on different ap. 
pearances. If the blood poured out in the 
kidney has happened to ftagnate for feme 
time in the ureters or bladder, it is fometimcs 
coagulated, and the coagulated part is after- 
wards broken down into a grumous mafs of a 
black or dark colour, and therefore gives the 
fame colour to tbe urine voided ; or if the 
quantity of broken down blood is fmall, it 
gives only abrownifh urine refembling coffee. 
It fometimes alfo happens, that the blood 
ftagnating and coagulating in the ureters, takes 
theform of thefevcffels, and is therefore voided 
under the appearance of a worm ; and if tl^e 
coagulated blood happens to have, as it may 
fometimes liave,the gluten feparated frojji the 
red globules, thefe wormlike appearances 
have their external furface whitifli, and the 
whole feemingly forming a tube containing a 
red liquor. I have fometimes obferved the 
blood which had feemingly been coagulated 
in the ureter, come away in an almoft dry 
Jftate, refembling the half burnt wick of a 


Thefe are the feveral appearances of the 
blood voided in the hematuria calculofa, when 



it proceeds efpecially from the kidneys or u- 
reter ; and many of the fame appearances are 
obferved when the blood proceeds only from 
the bladder when a ftoneis lodged there ; but 
the attending fymptoms will commonly point 
out the different feat of the difeafe. 

In one cafe, when a quantity of blood from 
the kidney or ureter is coagulated in the blad- 
der, and is therefore difficultly thrown out 
from this, the pain and uneafinefs on fuch an 
occafion may appear chiefly to be in the blad- 
der, though it contains no flone ; but the an- 
tecedent fymptoms will commonly difcover 
the nature of the difeafe. 


In any of the cafes of the hematuria calcu- 
lofa it will hardly be neceffary to* employ the 
remedies fuited to an a6live hemorrhagy. It 
will be proper only to employ the regimen fit 
for moderating hemorrhagy in general, and 
particularly here to avoid every thing or cir- 
cumftance that might irritate the kidneys or 
ureters. Of fuch cafes of irritation there is 
none more frequent or more confiderable than 
the prefcnce of hardened faeces in the colon ; 
andthefe therefore arc to be frequently remov- 
ed, by the frequent ufe of gentle laxatives. 



The hematuria calculofa may be properly 
confidered as a cafe of the hematuria violenta ; 



and therefore I fubjoin to that the other in^ 
fiances of hematuria from external violence ; 
fuch as that from external contufion on the 
region of the kidney, and that from the vio- 
lent or long continued exercife of the mufcles 
incumbent on the kidneys. An inflance of 
the latter caufe occurs efpecially in riding. 


It may alfo be confidered as a cafe of the 
hematuria violenta, when the difeafe occurs 
in confequence of the taking in of certain ac- 
rid fubftances, which pafs again efpecially by 
the urinary pafiTages ; and, by inflaming and 
IWelling the neck of the bladder, bring on a 
rupture of the over diftended blood veffels,. 
and give occafion to a bloody urine. The 
moft noted inflance of this is in the effcfl of 
cantharides in a certain quantity, any way in- 
troduced into the body. And poflibly fome 
other acrids may have the fame elfecl. 


Befide thefe moll frequent in (lances of 
hematuria, which cannot be confidered as id- 
iopathic hemorrhagies, there are fome other 
inflances of hematuria mentioned by authors, 
that are ftill however manifeflly fymptomat- 
ic ; fuch as a difcharge of blood from the u- 
rinary paffages, in confequence of a fuppref- 
lion of either the menftrual or hemorrhoidal 



flux. Thefe may be confidered as analogous 
to the hematemefis produced by the like cauf- 
es • and the feveral refleaions made above on 
that fubjea, will, 1 think, apply here and 
particularly the conclufions formed in 
MX XIV. Inftances, however, of either ot 
thefe cafes, and efpecially of the firft, have 
been extremely rare. 


Of fuch fymptomatic hematuria there is 
however one inflance deferving notice ; and 
that is, when a fuppreflion of the hemorrhoi- 
dal flux, either by a communication of vef- 
fels, or merely by the vicinity of parts, occa- 
fions a determination of the blood into the 
veflels of the neck of the bladder, which in 
confequence of a rixis or anaftomofis, pour 
out blood to be voided either with' or without 
the urine. This cafe is what has been nan>ed 
the Hemorrhoides Veficae ; and with fome 
propriety, when it ismanifefl;ly an evacuation 
vicarious of what had before been ufually 
made from the redum. With refpea to the 
management of the hemorrhoides veficae, I 
would apply the whole of the doarines that 
I have delivered above, with refpea to the 
cure of the proper hemorrhoidal affeaion. 


There remains fl:ill to be mentioned one 
other inllance of fymptomatic hematuria, 




which is that which happens in the cafeof con. 
fluent and putrid fmall pox, aswellasinfevcral 
other inflances of putrid dileafes. The blood, 
in fuch cafes, may be pretumcd to come from 
the kidneys ; and I apprehend that it comes 
from thence in confequence of that fluidity 
which is always produced in the blood ap- 
proaching to a putrid flate. Such hematuria, 
therefore, is not to be confidered as a fymp- 
tomof any aflFeftion of the kidneys, but merely 
as a mark of the putrefcent flate of the blood. 


In certain difeafes the urine is difcharged 
of fuch a deep red colour, as to give a fuf- 
picion of its being tinged by blood prefent in 
it ; and this has given occafion to Sauvages, 
amongfl the other fpecies of hematuria, to mark 
the hematuria fpuria, and the hematuria lateri- 
tia;both of which, however, he fuppofestobe 
without any blood prefent in the urine. In 
many cafes it is of importance, in afcertaining 
the nature of a difeafe, to determine whether 
the red colour of urine be from blood prefent 
in it, or from a certain flate of the falts and 
oils which are always in greater or lefTer pro- 
portion conllituent parts of the urine ; and 
the queflion may be commonly determined 
by the following confiderations. 

It has been obferved above, that when any 
confiderable quantity of blood is voided with 
the urine, there is always a portion of it de- 



i35ofited at the bottom of the veffel containing 
the voided blood and urine ; and in fuch a 
Gafe there will be no doubt in attributing the 
colour of the urine floating above to fome 
part of the blood diffufed in it. The quef- 
tion, therefore, with refpeft to the prelence 
of blood in the urine can only occur when n© 
fuch depofition as I have mentioned appears ; 
and when the blood that may be fuppoled to 
he prefent is diffolved or diffufed, and there- 
fore entirely fufpended in the urine. In this 
cafe the prefence of the blood may be com- 
monly known, ift. By the colour which blood 
gives, different from any urine without blood 
that I have ever feen ; and I think a little ex- 
perience will enable mofl perfons to make 
this dillinaion. 2dly, By this, that the pref- 
ence of blood always diminifhes the tranfpar- 
ency of the urine with which it is mixed ; and 
it is very feldom that urine, though very 
high coloured, lofes its tranfparency ; at leaft 
this hardly ever appears, if the urine i& 
examined when recently voided, sdly. When 
urine has blood mixed with it, it tinges a 
piece of linen dipped into it with a red colour, 
which the higheft coloured urine without 
blood, never does. 4thly, High coloured urine 
without blood, upon cooling, and remaining 
at reft in a veffel, almoft always depofites a 
lateritious fediment ; and if upon any occafion 
bloody urine fhould depofite a fediment that 
may be of a portion of the blood formerly dif- 
fufed in it, the difference, however, may be 



difcerned by this, that the fediment depofited 
by urine without blood, upon the urine's be- 
ing again heated, will be entirely redillolvcd, 
which will not happen to any fediment from 
blood. Laflly, we know no ftate of urine 
without blood, which fhews any portion of it 
coagulable by a heat equal to that of boiling 
water ; but blood difFufed in urine is ftill co- 
agulable by fuch a heat ; and by this teft, 
therefore, the prefence of blood in urine may 
be commonly afcertained. 






Former nofologiUs have 
eftablifhed a clafs of difeafes under the title of 
Fluxes, or Profluvia ; but as in this clafs they 
have brought together a great number of dif- 
eafes, which have nothing in common, ex- 
cepting the fingle circumftance of an increaf- 
ed difcharge of fluids, and which alfo are, in 
other refpe£ls, very different from one anoth- 
er ; I have avoided fo improper an arrange- 
ment, and have diftributed mod of the dif- 
eafes comprehended infuch a clafs by the nof- 
ologifts, into places more natural and proper 
for them. I have, indeed, ftill employed 
here the general title ; but I confine it to 



fuch fluxes only as are conflantly attended 
with pyrexia, and which therefore neceflarily 
belong to the clafs of difeafes of which I am 
now treating. 

Of the fluxes which may be confidered as 
being very conflantly febrile difeafes, there 
are only two, the catarrh and dyfentery ; and 
of thefe therefore I now proceed to treat. 






1 HE Catarrh .is an increafed 
excretion of mucus from the mucous mem- 
brane of the nofe, fauces, and bronchiae, at- 
tended with pyrexia. 

Pra6lical writers and nofologifts have dif- 
tinguilhed the difeafe by different appella- 
tions, according as it happens to afFe<5l thofe 
different parts of the mucous membrane, the 
one part more or lefs than the other : But I 
am of opinion, that the difeafe, although af- 
feding different parts, is always of the fame 
nature, and proceeds from the fame caufe. 
Very commonly, indeed, thofe different parts 
are affefted at the fame time ; and therefore 
there can be little room for the dilfcinftion 

The difeafe has been frequently treated of 
under the title of Tuflis, or Cough ; and a 



cough, indeed, always attends tlie chief form 
of catarrh, that is, the increafed excretion 
from the bronchise ; but a cough is fo often a 
fymptom of many other affe6lions, which are 
very different from one another, that it is im- 
properly employed as a generic title. 


The remote caufe of catarrh is mofl com- 
monly cold applied to the body. This ap- 
plication of cold producing catarrh, can in 
many cafes be diftinftly obferved ; and I be- 
lieve it would always be fo, were men ac- 
quainted with, and attentive to, the circum- 
ftances which determine cold to a6l upon the 
body. See XCIV— XCVI. 

From the fame paragra^s we may learn 
what in fomeperfons gives a predifpolition to 


The difeafc, of which I am now to treat, 
generally begins with fome difficulty of breath- 
ing through the nofe, and with a fenfe of 
fome fulnefs flopping up that paffage. This 
is alfo often attended with fome dull pain and 
a fenfe of weight in the forehead, as well as 
fome ftiffnefs in the motion of the eyes. Thefe 
feelings, fometimes at their very firfl begin- 
ning, and always foon after, are attended with 
the diftillation from the nofe ; and fometimes 



from the eyes, of a thin fluid, which is often 
found to be fomewhat acrid, both by its tafte, 
and by its fretting the parts over which it 


Thefe fymptoms conflitute the coryza and 
gravedo of medical authors, and are common- 
ly attended with a fenfe of laflitude over the 
whole body. Sometimes cold ftiiverings are 
fetf, at leaft the body is more fenfible than u- 
fual to the coldnefs of the air ; and with ail 
this the pulfe becomes, efpecially in the even- 
ings, more frequent than ordinary. 


Thefe fymptoms feldom continue long be- 
fore they are accompanied with fome hoarfe- 
nefs, and a fenfe of roughnefs and forenefs in 
the trachea, and with fome difficulty of breath- 
ing, attributed to a fenfe of ftraitnefs of the 
chefl, and attended with a cough, which 
feems to a rife from fome irritation felt at the 
glottis. The cough is generally at firft dry, 
occafioning pains about the cheft, and more 
efpecially in the breaft. Sometimes, togeth- 
er with thefe fymptoms, pains refembling 
thofe of the rheumatifm are felt insfeyeral 
parts of the body, particularly about the neck 
and head. While thefe fymptoms take place, 

Vol. 1 1. N the 


the appetite is impaired, fome thirfl arifet^, 
and a general laffitude is felt over all the body. 


Thefe fymptoms (MXLVIII— ML) mark 
the violence and height of the difeafe ; which, 
however, does not commonly continue long. 
By degrees the cough becomes attended with 
a copious excretion of mucus ; which is at 
firfl thin, but gradually becoming thicker, is 
brought up with lefs frequent and lefs labori- 
ous coughing. The hoarlenefs and forenefs 
of the trachea likewife going off, the febrile 
fymptoms abating, the cough becoming lefs 
frequent, and with lefs expettoration, the dif- 
eafe foon after ceafes altogether. 


Such is generally the courfe of this difeafe, 
which is commonly neither tedious nor dan- 
gerous ; but, upon fome occafions, it is in both 
refpeds otherwife. A perfon affefted with 
catarrh feems to be more than ufually liable 
to be affe6led by cold air ; and in that condi- 
tion, if expofed to cold, the difeafe, which 
feemed to be yielding, is often brought back 
with greater violence than before ; and is ren- 
dered not only more tedious than otherwife 
it would have been, but alfo more dangerous 
hy the fupervening of other difeafes. 


OF PHYSIC. 2;r9 


Some degree of the cynanche tonfillaris 
often accompanies the catarrh ; and, when the 
latter is aggravated by a frefh application of 
cold, the cynanche alfo becomes more violent 
and dangerous, in confequence of the cough 
which is prcfent at the fame time. 


When a catarrh has been occafioned by a 
violent caufe ; when it has been aggravated 
by improper management ; and efpecially 
when it has been rendered more violent by 
frefli and repeated applications of cold, it oft- 
en palFes into a pneumonic inflammation at- 
tended with the utmofl danger, 


Unlefs, however, fuch accidents as thofe of 
MLII — MLIV, happen, a catarrh, in found 
perfons not far advanced in life, is, I think, 
always a flight difeafe, and attended with 
little danger. But, in perfons of a phthifical 
difpofition, a catarrh may readily produce an 
hemaptyfis, or perhaps form tubercles in the 
lungs ; and more Certainly, in perfons who 
have tubercles already formed in the lungs, 
an accidental catarrh may occafion the inflam- 
N 2 raaiioii 


mation of thefe tubercles, and in confequence 
produce a phthifis pulmonalis. 


In elderly perfons, a catarrh fometimes 
proves a dangerous difeafe. Many perfons, 
as they adv^ance in life, and efpecially after 
they have arrived at old age, have the natur- 
al mucus of the lungs poured out in greater 
quantity, and confequently requiring a fre- 
quent expeftoration. If therefore a catarrh 
happen to fuch perfons, and increafe the af- 
flux of fluids to the lungs, with fome degree 
of inflammation, it may produce the peri- 
pneumonia notha, which in fuch cafes is 
very often fatal. See CCCLXXVI — 


The proximate caufe of catarrh feems to be 
an increafed afflux of fluids to the mucous 
membrane of the nofe, fauces, and bronchise, 
along with fome degree of inflammation af- 
fc6ling thefe parts. The latter circumftancc 
is confirmed by this, that in the cafe of ca- 
tarrh, the blood drawn from a vein, common- 
ly exhibits the fame inflammatory crufl; which 
appears in the cafe of phlegmafise. 




The application of cold which occafions a 
catarrh, probably operates by dimini/hing the 
pcrfpiration ufually made by the fkin, and 
which is therefore determined to the mucous 
membrane of the parts above mentioned. As 
a part of the weight which the body daily 
lofes by infenfible evacuation, is owing to 
an exhalation from the lungs, there is proba- 
bly a connexion between this exhalation and 
the cutaneous perfpiration, fo that the one 
may be increafed in proportion as the other 
is diminilhed : And therefore we may under- 
fland how the diminution of cutaneous pcr- 
fpiration, in ccnfequence of the application of 
cold, may increafe the afflux of fluids to the 
lungs, and thereby produce a catarrh. 


There are fome obfervations made by Dr. 
James Keil which may feem to render this 
matter doubtful ; but there is a fallacy in his 
obfervations. The evident efFefts of cold in 
producing coryza, leave the matter in general 
without doubt ; and there are feveral other 
circumftances which fhow a connexion be- 
tween the lungs and the furface of the body. 

N 3 MLX. 



Whether, from the fuppreflion of perfpira- 
tion, a catarrh be produced merely by an in- 
creafed afflux of fluids, or whether the matter 
of perfpiration be at the fame time determin- 
ed to the mucous glands, and there excite a 
particular irritation, may be uncertain ; but 
the latter fuppofition is fulhciently probable. 


Although, in the cafe of a common catarrh, 
which is in many inftances fporadic, it may be 
doubtful whether any morbific matter be ap- 
plied to the mucous glands j it is, however, 
certain, that the fymptoms of a catarrh do 
frequently depend upon fuch a matter being 
applied to thefe glands ; as appears from the 
cafe of meafles, chincough, and efpecially 
from the frequent occurrence of contagious 
and epidemical catarrh. 


The mention of this lafl leads me to ob- 
ferve, that there are two fpecies of catarrh, as 
I have marked in my Synopfis of Nofology. 
One of thefe, as I fuppofe, is produced by 
cold alone, as has been explained above ; and 
the other feems manifefl;ly to be produced by 
a fpecific contagion. 



Of fuch contagious catarrhs, I have point- 
ed out in the Synopfis many inftances occur- 
ring from the 14th century down to the prel- 
ent dgy. In all thefe inftances the phenom- 
ena have been much the fame ; and the diU 
eafe has always been particularly remarkable 
in this, that it has been the moft widely and 
generally fpreading epidemic knov/n. It ha.s 
leldom appeared in any one country of Eu- 
rope, without appearing fucceffively in every 
other part of it ; and in fome inftances, it has 
been even transferred to America, and has 
been fpread over that continent, fo far as we 
have had opportunities of being informed. 


The catarrh from contagion appears with 
nearly the fame fymptoms as thole mentioned 
MXLVIII — ML. It fcems often to come 
on in confequence of the application of cold. 
It comes on with more cold fhivering than 
the catarrh arifmg from cold alone, and Ibon- 
er ftiows febrile fymptoms, and thefe likewile 
in a more confiderable degree. Accordingly, 
it more fpeedily runs its courfe, which is com- 
monly finiflied in a few days. It fometimes 
terminates by a fpontaneous fweat ; and this, 
in fome perfons, produces a miliary eruption. 
It is, however, the febrile ftate of this difeafc 
efpecially, that is finifhed in a few days ; for 
the cough, and other catarrhal fymptoms, do 
frequently continue longer; and often, when 
N 4 they 


they appear to be going off, they are renewed 
by any frefh application of cold. 


Confidering the number of perfons who 
are aflPefted with catarrh, of either the one 
fpecies or the other, and elcape from it quick- 
ly without any hurt, it may be allowed to be 
a difeafe very free from danger ; but it is not 
always to be confidered as fuch ; for in fome 
perfons it is accompanied with pneumonic in- 
flammation. In the phthifically difpofed, it 
often accelerates the coming on of phthifis ; 
and in elderly perfons, it frequently proves 
fatal in the manner explained above, MLIV 
and MLVI. 


The cure of catarrh is nearly the fame, 
whether it proceed from cold or contagion ; 
with this difference, that in the latter cafe, 
remedies are commonly more necelfary than 
in the former. 

In the cafes of a moderate difeafe, it is 
commonly fiifEcient to avoid cold, and toab- 
Hain from animal food for fome days ; or per- 
haps to lie a bed, and, by taking frequently 
of fome mild and diluent drink a little warm- 
ed, to promote a very gentle fweat ; and af- 
ter thefe to take care to return very gradually 
only, to the ufe of the free air. 




When the difeafe is more violent, not only 
the antiphlogiftic regimen mufl be exactly 
obferved, but various remedies alio become 

To take oflF the phlogiftic diathefis which 
always attends this diieafe, bloodletting, in a 
larger or Imaller quantity, and repeated ac- 
cordmg as the fymptoms ihall require, is the 
proper remedy. 

For rellorinsf the determination of the flu- 
ids to the furface of the body, and at the fame 
time for expeding the fecretion of mucus in 
the lungs, which may take off the inflamma- 
tion of its membrane,, vomiting is the mod ef- 
fc61ual means. 

For the latter purpofe, it has been fuppof- 
ed, that fquills, gum ammoniac, the volatile 
alkali, and lome other medicines, might be 
iifeful : But their efficacy has never appeared 
to me to be confiderable ; and, if fquills have 
ever been very ufeful, it feems to have been 
rather by their emetic, than by their expedo- 
rant powers. 

When the inflammatory alFe^lions of the 
lungs feem to be confiderable, it is proper,, 
befides bloodletting, to apply bliftcrs on ibtne 
part of the thorax. 

As a cough is often the mofl troublefome- 
circumflance of this difeafe, fo demulcents. 

Vol. 2. N. 5 may 


may be employed to alleviate it. Sec 

But, after the inflammatory fymptoms have 
much abated, if the cough fhould Itill contin- 
ue, opiates atford the moft efFe6iual means of 
relieving it ; and, in the circumftances jult 
now mentioned, they may be very fafely em- 
ployed. See CCCLXXV. 

After the inflammatory and febrile ftates 
of this difeafe are almoll entirely gone, the 
mofl: eflFeftual means of difcuflfing all remains 
of the catarrhal affection, is by iome exercife 
of geftation dihgently employed. 






i HE dyfentery is a difeafe in 
which the patient has frequent ftools, accom- 
panied with much griping, and followed by a 
tenefmus. The ftools, though frequent, are 
generally in fmall quantity j and the matter 
voided is chiefly mucus, fometimes mixed 
with blood. At the fame time, the natural 
faeces feldom appear ; and, when they do, it 
is generally in a compaQ; and hardened form.. 


This difeafe occurs efpecially in fummer 
and autumn, at the fame time with autumnal 
intermittent and remittent fevers ; and with 
thefe it is fometimes combined or complicat- 




The difeafe comes on fometimes with cold 
fhiverings, and other fymptoms of pyrexia ; 
but more commonly the fymptoms ot the top- 
ical afFedion appear firft. The belly is cof- 
tive, with an unufual flatulence in the bowels. 
Sometimes, though more rarely, fome degree 
of diarrhoea is the firft appearance. In mofl 
cafes the difeafe begins with griping, and a 
frequent inclination to go to ftool. In indulg- 
ing this, little is voided ; but fome tenefmus 
attends it. By degrees the ftools become more 
frequent, the griping more fevere, and the te- 
nefmus more confiderable. Along with thcfe 
fymptoms there is a lofs of appetite ; and fre- 
quently ficknefs, naufea, and vomiting, alfo 
aftefting the patient. At the fame time there 
is always more orlefs ofpyrexiaprefent, which 
is fometimes of the remittent kind, and ob- 
ferves a tertian period. Sometimes the fever 
is manifeftly inflammatory, and very often of 
a putrid kind. Thefe febrile flates continue 
to accompany the difeafe during its whole 
courfe, efpecially when it terminates foon in 
a fatal manner. In other cafes, the febrile 
flate almofl entirely difappcars, while the 
proper dyfenteric fymptoms remain for a lorlg 
time after. 




In the courfe of the difeafe, whether of a 
fhorter or longer duration, the matter voided 
by flool is very various. Sometimes it is 
merely a mucous matter, without any blood, 
exhibiting that difeafe which Dr. Roderer has 
named the morbus miicofus^ and others the 
dyfenteria alba. For the mofl part, however, 
the mucus difcharged is more or lefs mixed 
with blood. This fometimes appears only in 
flreaks amongfl the mucus ; but at other times 
is more copious, tinging the whole of the 
matter difcharged ; and upon fome occafions 
a pure and unmixed blood is voided in con- 
liderable quantity. In other refpedls, the 
matter voided is varioufly changed in colour 
and confiftence, and is commonly of a flrong 
and unufually fetid odour. It is probable, 
that fometimes a genuine pus is voided ; and 
frequently a putrid fanies, proceeding from 
gangrenous parts. There are very often 
mixed with the liquid matter fome films of a 
membranous appearance, and frequently fome 
fmall maffes of a feemingly febaceous matter. 


While the flools confiRinsc of thefe various 
matters, are, in many inllances, exceedingly 
frequent, it is feldom that natural faeces ap- 
pear in them ; and when they do appear, it 



is, as I have mentioned, in the form of fcyba- 
la, that is, in fomewhat hardened, feparate 
bzdls. When thefe are voided, whether by 
the eflForts of nature, or as fohcited by art, 
they procure a remifiion of all the fymptoms, 
and more eipecially of the frequent flools, 
griping, and tenefmus. 


Accompanied with thefe circum fiances, the 
difeafe proceeds for a longer or a fhorter time. 
When the pyrexia attending it is of a violent 
inflammatory kind, and more efpecially when 
it is of a very putrid nature, the difeafe often 
terminates fatally in a very few days, with all 
the marks of a fupervening gangrene. When 
the febrile ftate is more moderate, or difap- 
pears altogether, the difeafe is often protraft- 
ed for weeks, and even for months ; but, even 
then, after a various duration, it often termin- 
ates fatally, and generally in confequence of 
a return and confiderable aggravation of the 
inflammatory and putrid Hates. In fome 
cafes, the difeafe ceafes fpontaneoufly ; the 
frequency of ftools, the griping, and tenefmus, 
gradually diminilhing, while natural llools 
return. In other cafes, the difeafe, with mod- 
erate fymptoms, continues long, and ends in a 
diarrhoea, fometimes accompanied with lien- 
teric fymptoms. 




The remote caufes of this difeafe have been 
varioufly judged of. It generally arifes in 
fummer or autumn, after confiderable heats 
have prevailed for fome time, and efpecially 
after very warm and at the fame time very dry 
ftates of the weather ; and the difeafe is much 
more frequent in warm, than in cooler cli- 
mates. It happens, therefore, in the fame 
circumftances and feafons which confiderably 
affeft the ftate of the bile in the human body ; 
but as the cholera is often without any dyfen- 
teric fymptoms, and copious difcharges of bile 
have been found to relieve the fymptoms of 
dyfentery, it is difficult to determine what 
connexion the difeafe has with the ilate of the 


It has been obferved, that the eflfluvia from 
very putrid animal fubftances, readily alTeft 
the alimentary canal ; and upon fome occa- 
fions they certainly produce a diarrhoea ; but, 
whether they ever produce a genuine dyfen- 
tery, I have not been able to learn with cer- 


The dyfentery does often manifeflly arife 
from the application of cold, but the difeafe 




is always contagious ; and, by the propagation 
of fuch contagion, independent of cold, 01 
other exciting caules, it becomes epidemic in 
camps and other places. ' It is, therefore, to 
be doubted, if the application of cold does 
ever produce the difeafe, unlefs where the 
Ipecific contagion has been previoufly receiv- 
ed into the body : And upon the whole, it is 
probable, that a fpccific contagion is to be 
confidered as always the remote caufe of this 


Whether this contagion, like many others, 
be of a permanent nature, and only fhows its 
effefts in certain circumflances which render 
it a6live, or if it be occafionally produced, I 
cannot determine. Neither, if the latter fup- 
pofition be received, can I fay by what mean 
it may be'generated. As little do we know- 
any thing of its nature, confidered in itfelf ; 
or at moft this only, that, in common with 
many other contagions, it appears to be com- 
monly of a putrid nature, and capable of in- 
ducing a putrefcent tendency in the human 
body. This, however, does not at all explain 
its peculiar power in inducing thofe fymptoms 
which properlv and elfenLially confiitute the 
difeafe of dyfcntcry. (MLXVIIj. 




Of thefe fymptoms the proximate caufe h 
ftill obfcure. The common opinion has been, 
that the difeafe depends upon an acrid matter 
received into, or generated in the inteftines 
themfelves, exciting their periftaltic motion, 
and thereby producing the frequent ftools 
which occur in this difeafe. But this fuppo- 
fition cannot be admitted ; for, in all the in- 
flances known of acrid fubftances applied to 
the inteftines and producing frequent ftools, 
they at the fame time produce copious ftools, 
as might be expe6led from acrid fubftances 
applied to any length of the inteftines. This, 
however, is not the cafe in dyfentery ; in 
which the ftools, however frequent, are gen- 
erally in very fmall quantity, and fuch as may 
be fuppofed to proceed from the lower parts 
of the reaum only. With refped to the fu- 
perior portions of the inteftines, and particu- 
larly thofe of the colon, it is probable they 
are under a preternatural and confiderable 
degree of conft ri6lion : For, as I have obferv- 
ed^above, the natural faeces are feldom void- 
ed ; and when they are, it is in a form which 
gives reafon to fuppofe, they have been long 
retained in the cells of the colon, and confe- 
quently that the colon had been affeaed with 
a preternatural conftri61ion. This is confirm- 
ed by almoft all the dilTeaions which have 
been made of the bodies of dyfenteric patients, 



in which, when gangrene had not entirely 
deftroyed the texture and form of the parts, 
confiderable portions of the great guts have 
been found affedled with a very confiderable 


I apprehend, therefore, that the proximate 
caufe of dyfentery, or at leaft the chief part 
of the proximate caufe, confifts in a preternat- 
ural conftri6lion of the colon, occafioning at 
the fame time thofe fpafmodic efforts which 
are felt in fevere gripings, and which eflPorts, 
propagated downwards to the reftum, occa- 
iion there the frequent mucous flools and te- 
nefmus. But, whether this explanation (hall 
be admitted or not, it will flill remain certain, 
that hardened fasces retained in the colon are 
the caufe of the griping, frequent ftools, and 
tenefmus ; for the evacuation of thefe faeces, 
whether by nature or by art, gives relief from 
the fymptoms mentioned ; and it will be more 
fully and ufefully confirmed by this, that the 
mofl immediate and fuccefsful cure of dyfen- 
tery is obtained by an early and conftant at- 
tention to the preventing the conftri6lion, and 
the frequent ftagnation of fasces in the colon. 


In this manner I have endeavoured to af- 
certain the proximate caufe of dyfentery, and 



therefore to point out alfo the principal part 
of the cure, which, from want of the proper 
view of the nature of the difeafe, feems to 
have been in feveral refpefts flu6luating and 
undetermined among pra6litioners, 


The mofl eminent of our late pra6tition- 
ers, and of greateft experience in this difeafe, 
feem to be of opinion, that the difeafe is to 
be cured mofl efi-e6lually by purging affidu- 
oufly employed. The means may be lari- 
ous ; but the mofl gentle laxatives are ufually 
fufficient ; and as they muft be frequently re- 
peated, the mofl gentle are the mofl fafe ; the 
more efpecially as an inflammatory ftate fo 
frequently accompanies the difeafe. What- 
ever laxatives produce an evacuation of nat- 
ural faeces, and a confequent remilTion of the 
fymptoms, will be fufficient to efFecluate the 
cure. But if gentle laxatives fhall not pro- 
duce the evacuation now mentioned, lome 
more powerful medicines muft be employed ; 
and I have found nothing more proper or 
convenient than tartar emetic, given in fmall 
dofes, and at fuch intervals as may determine 
their operation to be chiefly by flool. Rhu- 
barb, fo frequently employed, is in feveral re- 
fpe6ls amongfl the mofl improper purga- 




Vomiting has been held a principal remedy 
in this difeafe ; and may be ulefully employ- 
ed in the beginning of it, with a view to both 
the ftate of the flomach and of the fever ; but 
it is not neceflary to repeat it often ; and un- 
lefs the emetics employed operate alfo by flool, 
they arc of little fervice. Ipecacuanha feems 
to polTefs no fpecific power ; and it proves 
only ufeful when fo managed as to operate 
chiefly by flool. 


For relieving the conftridion of the colon, 
and evacuating the retained fccces,glyflers may 
fometimes be ufeful; but they are feldom fo 
efFe6lual as laxatives given by the mouth ; and 
acrid glyfters, if they be not effeftual in evac- 
uating the colon, may prove hurtful by flim- 
ulating the reftum too much. 


The frequent and fevere griping attending 
this difeafe, leads almofl necelTarily to the ufe 
of opiates, and they are very elFe6lual for the 
purpofe of relieving from the gripes ; but by 
occafioning an interruption of the a6lion of 
the fmall guts, they favour the confl;ri6lion 
of the colon, and thereby fometimes aggravate 


O F P H Y S I C. 297 

the difeafe ; and if at the fame time the ufe 
of them fuperfede in any meafure the em- 
ploying of purgatives, it commonly does much 
mifchief ; I believe it indeed to be only the 
negleft of purging that renders the ufe of o- 
piates very neceflary. 


When the gripes are both frequent and fe- 
vere, they may fometimes be relieved by the 
employment of a femicupium, or by a fomen- 
tation of the abdomen, continued for fome 
time. In the fame cafe, the pains may be 
relieved, and, as I think, the conftriftion of 
the colon may be taken off, by blifters applied 
to the lower belly. 


At the beginning of this difeafe, when the 
. fever is any way confiderable, bloodletting, in 
patients of tolerable vigour, may be proper 
and neceffary ; and, when the pulfe is full 
and hard, with other fymptoms of an inflam- 
matory difpofition, bloodletting ought to be 
repeated. But, as the fever attending dyfen- 
tery is often of a putrid kind, or does, in the 
courfe of the difeafe, become foon of that na- 
ture, bloodletting muft be employed with 
^reat caution. 




From the account now given of the nature 
of this difeafe, it will be fufficiently obvious, 
that the ufe of aflringents in the beginning of 
it muft be abfolutely pernicious. 


Whether an acrid matter be the original 
caufe of this difeafe, may be uncertain ; but 
from the indigeftion and the flagnation of flu- 
ids in the flomach which attend the difeafe, it 
may be prefumed, that fome acrid matters 
are conflantly prefent in the ftomach and in- 
teftines, and therefore that demulcents may 
be always ufefuUy employed. At the fame 
time, from this confideration that mild oily 
matters throAvn into the inteftines in confider- 
able quantity always prove laxative, I am of 
opinion that the oleaginous demulcents are 
the moil ufcful. 


As this difeafe is fo often of an inflammato- 
ry or of a putrid nature, it is evident that the 
diet employed in it fhould be vegetable and 
acefcent. Milk in its entire fl:ate is of doubt- 
ful quality in many cafes ; but fome portion 
of the cream is often allowable, and whey is 
always proper. 



In the firfl: ftages of the difeafe, the fweet 
and fubacid fruits are allowable, and even 
proper. It is in the more advanced ftages 
only that any morbid acidity feems to prevail 
in the ftomach, and to require fome referve 
in the ufe of acefcents. At the beginning of 
the difeafe, abforbents feem to be fuperfluous ; 
and by their aftringent and feptic powers they 
may be hurtful. 


When this difeafe is complicated with an 
intermittent fever, and is protrafted from that 
circumftance chiefly, it is to be treated as an 
intermittent, by adminiftering the Peruvian 
bark, which, however, in the earlier periods 
of the difeafe, is hardly to be admitted. 



eu/Y/oje^ , 07> 

Jy e'Z'VotM zJJu&ai&d. 


N a ceftain view, alniofl the 
whole of the difeales of the hu- 
man body might be called 
Nervous :. But there would 
be no ufe for fuch a general 
appellation ; and, on the other 
hand, it feems improper to limit the term, in 
the loofe inaccurate manner in which it has 
been hitherto applied, to hyfteric or hypo- 
chondriacal diforders, which are themfelves 
Tiardly to be defined with fufficient precifion. 


In this place I propofe to comprehend^ 

under the title of Neuroses, all thofe pre- 

VoL. IL O ternatural 



ternatural afFeftions of fenfe or motion which 
are without pyrexia, as a part of the primary 
difeafe j and all thofe which do not depend 
upon a topical afFe6lion of the organs, but 
upon a more general affeftion of the nervous 
lyflem, and of thofe powers of the fyflem up- 
on which fenfe and motion more efpecially 


Of fuch difeafes I have eftablilhed a clafs, 
under the tide of Neuroses, or Nervous 
Diseases. Thefe I again diftinjuifh, as 
they confift, either in the interruption and de- 
bility of the powers of fenfe and motion, or 
in the irregularity with which thefe powers 
are exercifed j and have accordingly arranged 
them under the four orders of Comata, Adyna- 
mi<e, Spafmit and Vefania^ to be defined as we 
proceed to treat of them more particularly. 







UNDER this title are com- 
prehended thofe aiFeftions which have been 
commonly called the Soporofe difeafes ; but 
they are mod properly diftinguifhed by their 
confifting in fome interruption or fuppreflion 
of the powers of fenfe and voluntary motion, 
or of what are called the animal fun6lions. 
Thefe are indeed ufually fufpended in the 
time of natural fleep : But of all the difeafes 
to be comprehended under our title, fleep, or 
even the appearance of it, is not confbantly a 
fymptom. Of fuch difeafes I can mark and 
properly explain two genera onlyj which come 
under the titles of Apoplexy and Palfy. 

O 2 






Apoplexy is that difeaR: 

m which the whole of the external and inter- 
nal fenfes, and the whole of the voluntary 
motions, are in fome degree aboliflied ; while 
refpiration and the a6lion of the heart contin- 
ue to be performed. By its being an affec- 
tion of the xjuhok of the powers of fenfe and 
of voluntary motion, we diflinguilh it from 
Palfy ; and by its being with the continuance 
of refpiration and the aftion of the heart, it is 
diftinguifhed from Syncope. I have further 
added to the ordinary definition of apoplexy, 
that the abolition of the powers of fenfe and 
inotion is in jome degree only 5 meaning by 
this to imply, that, under the title of Apo- 
plexy, are here comprehended thofe difeafes 
which, as differing from it in degree only^ 
cannot, with a view either to pathology or 
pra^licC) be properly diftinguifhed from it : 



Such are the difeafes fometimes treated of un- 
der the names of CaruSy Caiaphora, Coma, and 


Apoplexy, in all its different degrees, moft 
commonly affeds perfons advanced in life, 
and efpecially thofe above fixty years of age. 
It moa ufually affefts perfons of large heads 
andfliort necks, perfons of a corpulent habit 
perfons who have paffed an indolent life and 
ufed a full diet, and efpecially thofe who have 
indulged in frequent intoxication. Men who 
have long laboured under a frequent and co- 
pious difcharge of blood from the hemorrhoi- 
dal veffelsi upon either the fuppreffion or 
fpontaneous ceafing of that difcharge, are par- 
ticularl)^ liable to be affeded with apoplexy. 


This difeafe frequently comes on very fud- 
denly : But in many cafes it is preceded by 
various fymptoms, fuch as frequent fitsotgid- 
dinefs, frequent headachs, a hemorrhagyfroni 
the nofe, fome tranfitory interruptions of fee- 
ing and hearing, fome falfe vifion and hear- 
ing, fome tranfitory degree of numbnefs or lols 
of motion in the extremities, fome faltering ot 
the tongue in fpeaking, a lofs of memory, a 
frequent drowfinefs, and frequent fits of in- 

'^^^"^- 03 MXCVII: 



An attention to thefe fyraptoms, and to the 
predifponent circumftances (MXCV), will 
often enable us to forefee the more violent at- 
tacks of this diieafe. 


When the difeafe comes on fuddenly to a 
confiderable degree, it has been frequendy 
obferved to have been immediately induced 
by violent exercife ; by a full and long con- 
tinued infpiration ; by a fit of anger ; by much 
external heat, efpecially that arifing from a 
crowded affembly of people ; by warm bath- 
ing ; by intoxication ; by long {looping with 
the head down ; and by a tight ligature about 
rh.-^ r>'-rV. T^he direafc has been remarked to 

lIIKJ XX'^'^Z^, 

make its attacks mofl frequently in the fpring 
ieafon, and efpecially when the vernal heat 
fuddenly fucceeds to the winter cold. 


The fymptoms denoting the prefence of 
this difeafe will be fufficiently known from 
the definition given MX CIV. Although the 
whole of the body is afFe6ted with the iofs of 
fenfe and motion, it fometimes takes place 
more upon one fide of the body than the oth- 
er ; and, in that cafe, the fide leafl affeded 



with palfy IS fometimes affecled with convul, 
^ons."^ in th.s d^feafe there . often a ftenor 
ous breathing ; and this has been [^^1 to ^^^^ 
mark of the moll violent ftate of the dileale 
Zt It is not always prefent even m the moft 
complete form or moll Vioknt degree of the 


The proximate caufe of this difeafe may be 
in general, whatever interrupts the motion ot 
Ihe'Lrvous power from the bram to the -^^ 
cles of voluntary motion ; or, in fo far as lenle 
1 aff^^aed whatever interrupts the motion of 
the nen o^s power from the fentient extrem^- 
ities of the nerves to the brain. 


Such an interruption of the motion, of the 
nervous power may be occafioned, either l^y 

™:.'r.#on o/tkeor^s^n of the nerves, or 

% foJh^n, ^^/7-f,/,t%rut 'welu^^^ 
nervoui power. Both tneie tauic ^ , 
treat of more particularly ; and, B^Mf ^^a 
of compreflion, feem.r>gly the -""f f"=q^™' 
occafion of apoplexy, and P"1'='P^ ''^%°";: 
fion of all thofe apoplexies arifing from mter- 

nal caufes* 

O 4 MCIIi. 



The lofs of fenfe and motion in particular 
parts of the body, may be occafioned by a 
compreflion, either of the origin of certain 
nerves only, or of the fame nerves in fome 
part of their courfe from the brain to the or- 
gans of fenfe and motion. Such cafes of par- 
tial compreflion will be more properly con- 
fidered hereafter ; and the affe6lion I am 
now to treat of being general, it muft depend 
upon a very general comprefTion of the origin 
of the nerves, or medullary portion of the 
brain ; and therefore, this more general com- 
preflion only is to be confidered here. 


This compreflion of the origin of the 
nerves, or medullary portion of the brain, 
may be produced in different ways ; as, 

1. By external violence frafturing and 
prefling in a part of the cranium. 

2. By tumours, fometimes foft, fometimes 
bony, formed in di Querent parts of the brain, 
or in its membranes, and becoming of fuch a 
bulk as to comprefs the medullary fubftance 
of the brain. 

3. By the blood accumulated in the blood- 
velfels of the brain, and di (lending them to 
fuch a degree as to comprefs the medullary 
ponion of the fame. 

4. By 


4. By fluids efFufed in different parts of 
the brain, or into the cavity of the cranium, 
and accumulated in fuch quantity as to occa- 
fion the compreflTion we treat of. 

And, as to this laft, it is to be remarked 
here, that the fluids effufed may be of two 
kinds ; that is, they may be either a portion ■ 
of the common mafs of blood, poured oat: 
from red veflels ; or a portion of ferum 01 
colourlefs fluid, poured out chiefly by exha- 
lants. . 

MClV. . 

Of thefe feveral caufes of comprcfTion, the 
firft is not to be confidered here, becaufe the 
removing it docs not belong to our province ; 
and the confideration of the fecond may be 
omitted, as in moft inftances it is neither to 
be difcerned nor cured by any means yet 
known. The third and fourth caufes of 
comprcfTion, as they are the moft frequent, 
and are alfo mod properly the fubjc6ls of our 
.irt, fo they are thofe which deferve our par- 
ticular attention ; and we Ihall therefore en- 
deavour to trace them further back in the fe- 
ries of caufes which may produce them.. 


Both the ftates of over diftention and of 
cff'ufion, may be produced by whatever in- 
creafes the afflux and impetus of the blood in 

Vol. 2. O 5 the 



the arteries of the head ; fuch as violent exer- 
cite, a violent fit ot anger, external heat ap- 
plied, or any flrong preffure upon the de- 
iccuding aorta. 


But both thefe ftates of over diflention and 
of effufion, may alfo and feem to be more 
frequently produced by caufes that operate 
by preventing the free return of the venous 
blood from the veJGTels of the head to the right 
ventricle of the heart. 


The venous veffels of the brain are of a 
conformation and diftribution fo peculiar, as 
lead us to believe, that Nature intended to 
retard the motion of the blood, and accumu- 
late it in thefe velfels; and therefore, even very 
Imall additional refiftances to the motion of 
the blood from thefe towards the right ventri- 
cle of the heart, may ftill more readily accu- 
mulate the blood in them. Such accumula- 
tion will moft readily happen in advanced 
life, when the venous fyftem in general is in 
a plethoric ftate, and when this plethora takes 
place efpecially in the venous veffels of the 
brain. It will, in like manner, be moft apt 
to occur in perfons whofe heads are large 
with refpeft to the reft of the body ; and in 
perfons of a fhort neck, which is unfavourable 


OF P H Y S I C. 311 

lb the return of the venous blood frop the 
head. The accumulation of blood in the 
venous vefTels of the brain, will alio be mofl 
likely to occur in perfons of a corpulent habit, 
either becaufe thefe may be confidered to be 
in a plethoric ftite, or becaufe obefity, by oc- 
cafioning a compreffion of the bloodveffels 
in other parts of the body, more readily fills 
thofe of the brain, which are entirely free 
from any fuch compreffion. 


Thefe are the circumflances in the confti-- 
tution of the body, which, producing a flow- 
er motion and return of the venous blood 
from the veflels of the head, favour an accu- 
mulation and diftention in them ; and we now 
proceed to mention the feveral occalional 
caufes, which, in every perfon, may direftly 
prevent the free return of the blood from the 
veffels of the head towards the heart. Such 

1. Stooping down with the head, or other 
fituations of the body in which the head is 
long kept in a depending ftate, and in which 
the gravity of the blood increafes the afflux of 
it by the arteries, and oppofes the return of it 
hy the veins. 

2, A tight ligature about the neck, which 
compreflTes the veins more (trongly than the 

06 3. Any 


3. Any obflru6lionof aconfiderable num- 
ber of the veins carrying the blood from the 
head, and more el'pecially any confiderable 
obfi;ru6lion of the afcending vena cava. 

4. Any confiderable impediment of the 
free pafl'age of the blood from the veins into 
t!ie right ventricle of the heart ; and it is com- 
monly by this, and the immediately preceding 
circumftance, that polypous concretions in 
the cava, or right ventricle, are found to occa- 
fion apoplexy. ^ 

5. The return of blood from the veins of 
the head towards the heart, is efpecially inter- 
rupted by every circumftance that produces a 
more difficult tranfmiffionof the blood through 
the veffels of the lungs. It is well known, 
that, at the end of every expiration, fome in- 
terruption is given to the free tranfmiffion of 
the blood through the lungs ; and that this at 
the fame time gives an interruption to the 
motion of the blood from the veins into the 
right ventricle of the heart. This clearly ap- 
pears from that regurgitation of the blood in 
the veins which occafions the ahernate heav- 
ing and fubiiding that is perceived in the 
brain of living animals when the cranium is 
removed, and which is obferved to be fyn- 
chronous with the alternate motions of refpi- 
ration. From this we readily perceive, that 
whatever occafions a difficulty in the tranf- 
miffion of the blood through the lungs, mud 
alfo interrupt the free return of the venous 
blood from the veffels of the head j and muft 



therefore favour, and perhaps produce, an ac- 
cumulation of blood, and an over diflention 
in thefe vefTels. 

It is further to be obferved, that as a very- 
full infpiration, continued for any length of 
time, occafions fuch an interruption of the 
free tranfmiffion of the blood through the 
lungs, as produces a fufFufion of face, and a 
manifeft turgefcence of the blood veffels of 
the head and neck ; fo every full and long 
continued infpiration may occafion an acco- 
mulation of blood in the veffels of the head, 
to a very confiderable degree. Thus, as ev- 
ery ftrong exertion of the mufcular force of 
the body requires, and is attended with, a 
very full and long continued infpiration, we 
thence learn why the violent exertions of 
mufcular force have been fo often the imme- 
diate or exciting caules of apoplexy. 

It may alfo be remarked, that corpulency 
and obefity feem to operate very much, by 
occafioning a more difficult tranfmiffion of 
the blood through the veffels of the lungs. It 
appears, that in fat perfons, from the compref- 
fion of the bloodveffels in many parts of the 
body, the veffels of the lungs are thereby 
kept very full ; fo that upon the leaft increafe 
of bodily motion, which fends the blood fafter 
into the lungs, a more frequent and laborious 
refpiration becomes in fuch perfons imme- 
diately neceffary. This fhows, that, in fuch 
perfons, the blood is not freely tranfmitted 
through the lungs ; a circumilance which, as 



in other inftances, fnuft give a conflantrefift- 
ance to the return of blood from the vefTels 
of the head, and therefore favour or occafion 
an accumulation of blood in them. 

Is the motion of the blood in the vefTels of 
the head rendered flower by lludy, care, and 
anxiety ? 


It is to be obferved further, that thefe fev- 
eral caufes (MCV— MCVIII) of a preter- 
natural fulnefs in the bloodveflfels of the brain, 
may produce apoplexy in different ways, ac- 
cording as the fulnefs takes place in the arte- 
ries or in the veins. 


Accordingly, firji, the increafcd afflbbi of 
blood into the arteries of the brain, and an in- 
creafed aftion in thefe, may either occafion a 
rupture of their extremities, and thereby an 
effufion of red blood producing comprelTion ; 
or the fame afflux and increafed a£lion may 
occafion an increafed exhalation from th^ii' 
extremities, of a fferous fluid, which, if not as 
cjnickly reabforbed, may foon accumulate irt' 
fUch quantity as to produce compreffion. 




Secondly, The plethoric ftate of the venous 
veffels of the brain, may operate in three dif- 
ferent ways. 

1. The fulnefs of the veins may give fuch 
refiflance to the blood flowing into them from 
the arteries, as to determine the impetus of 
the blood to be fo much greater upon the ex- 
tremities of the arteries as to occafion a rup- 
ture of thefe, and confequently an efFufion of 
red blood, or the H^morrhagia cerebri, which 
Hoffman confiders as a frequent caufe of 
apoplexy, and which we have before explain- 
ed in DCCLXXII. 

2. Whilft the fame refiftance to the blood 
flowing from the arteries into the veins, in- 
creafes the impetus of the blood in the former, 
this may, without occafioning rupture, in- 
creafe the exhalation from their exhalant ex- 
tremities, and produce an eff^ufion of a ferous 
fluid ; in the fame manner as fuch refift:ance 
in the veins produces hydropic efFufions in 
other parts of the body. 

3. If we may fuppofe, as no lymphatics 
have been yet difcovered in the brain, that 
the ordinary abforbents are not prefent there, 
and that the exhaled fluids are abforbed or 
taken up by the extremities of the veins ; 
this will ftiow ftill more clearly that a refift- 
ance to the motion of the blood in the vems 
of the brain, may readily produce an accumu- 

3t6 PR A C T I G E 

lation of ferous fluid in its cavities, and con- 
fcquently a compreffion producing apoplexy. 


Befides thefe cafes of apoplexy from af- 
flux in the arteries, or refiflance in the veins, 
an effufion of ferum may happen from two 
other caufes. The one is a relaxation of the 
exhalants, as in other cafes of hydropic dia^- 
thefts prevailing in the body ; and it is not 
unufual for a general dropfy to end in apou- 
plexy. The fecond is an over proportion of 
watery parts in the mafs of blood, which i 
therefore ready to run off by the exhalants, as 
in the cafe of an ifchuria renalis ; which when 
it proves incurable, very commonly termin- 
ates in apoplexy. 


We have now mentioned the feveral caufes 
of apoplexy depending upon compreffion ; 
and from the whole it will appear, that the 
moft frequent of all thefe caufes is a plethoric 
ftate, or an accumulation and congcflion of 
blood in the venous veflels of the head, ope- 
rating, according to its degree, in producing 
over diflention or effufion. The frequent 
operation of fuch a caufe will efpecially ap- 
pear from a confideration of the prtdif'ponent 
circum fiances (MXCV), and from the ante- 
cedent fymptoms (MXCVI). *' 


O F P H Y S I C. 3^7 


From the view I have now given of the 
caufes of apoplexy arifing from compreffion, 
it will readily appear that there is a founda- 
tion for the common diflinftion of this dif- 
eafe into the two kinds of Sanguine and Se- 
rous. But this diftinftion cannot be very 
ufefully applied in pra6lice, as both kinds 
may often depend on the fame caufe, that is, 
a venous plethora, and therefore requiring 
very nearly the fame method of cure. The 
only diflinaion that can be properly made of 
apoplexies from compreffion, is perhaps the 
diftinaion of ferous apoplexy, into that de- 
pending on the plethora mentioned MCXIII, 
and that depending upon hydropic diathefis 
or an over proportion of water in the blood 
(MCXII) ; the former caufes giving a prop- 
er idiopathic, the latter oply a fymptomatic, 


Befide the caufes now mentioned, occa- 
fioning apoplexy by compreffion, I allege 
there are other caufes producing the fame 
difeafe, by direftly deflroying the mobility 
of the nervous power. Such caufes feem to 
be the mephitic air arifing from fermenting 
liquors, and from many other fources ; the 
fumes arifing from burning charcoal ; the 



fumes of mercury, of lead, and of fome other 
mc tallic fubftances ; opium, alcohol, and 
mr.ny other narcotic poifons : To all which I 
would add the power of cold, of concufTion, 
of elefh-ieity, and of certain paflions of the 


None of thefe poifons or noxious powers 
feem to kill by a6ting firft upon the organs of 
refpiration, or upon the fanguiferous fyflem ; 
and I believe their immediate and direft ac- 
tion to be upon the nervous power, deftroying 
its mobility, becaufe the fame poifons fhotv 
their power in deftroying the irritability of 
mufclcs and of the nerves conne6led with 
them, when both thefe are entirely feparated 
from the reft of the body. 


It appears to me probable, that the apo- 
pleflic ftate in fome degree accompanying, 
and almoft always fucceeding, an epileptic 
paroxyfm, does not depend upon compref- 
lion, but upon a certain ftate of immobility 
of the nervous power, produced by certain 
circumftances in the nervous fyftem itfelf, 
which fometimes feem to be communicated 
from one part of the body to another, and 
at length to the brain. 




The fame obfervation may be made wifh 
refpeft to many inftances of hyfteric parox- 
yfm ; and the circumflances, both of epilep- 
tic and hyfteric paroxyfms, ending in coma, 
or a degree of apoplexy, lead me to think, 
that alfo the apoplexy proceeding from retro- 
cedent or atonic gout is of the fame kind, or 
that it depends upon an immobility of the 
nervous power, rather than upon compreffion, 


It may indeed happen, that as the apo- 
ple6itic and gouty predifpofitions do often 
concur in tut tame perion ; fo it may conie- 
quently happen, that the apoplexy coming 
upon gouty perfons, may fometimes depend 
upon compreflion ; and diffeftions may, ac- 
cordingly, difcover that the circumftances of 
fuch a caufe had preceded. 

But, ia many cafes of apoplexy following a 
retrocedent or atonic gout, no fuch antecedent 
or concomitant circumftances, as commonly 
occur in cafes of compreftion, dodiftinftly or 
clearly appear ; while others prefent them- 
felvcs, which point out an affe6lion of the 
nervous power alone. 




With refpe6l, however, to the circum- 
flances which may appear upon the diffeftion 
of perfons dead of apoplexy, there may be 
fome fallacy in judging, from thofe circum- 
flances, of the caufe of the difeafe. What- 
ever takes ofF or diminifhes the mobility of 
the nervous power, may very much retard 
the motion of the blood in the veffels of the 
brain ; and that perhaps to the degree of in- 
creafing exhalation, or even of occafioning 
rupture and eflFufion ; fo that, in fuch cafes, 
the marks of comprefTion may appear, upon 
difledion, though the difeafe had truly de- 
pended on caufes deftroying the mobility of 
the nervous power. This feems to be illuf- 
trated and confirmed from what occurs in 
many cafes of epilepfy. In fome of thefc, 
after a repetition of fits, recovered from in 
the ufual manner, a fatuity is induced, which 
commonly depends upon .a watery inunda- 
tion of the brain : And in other cafes of epi- 
lepfy, when fits have been often repeated 
without any permanent confequence, there 
Iiappens at length a fatal paroxyfm ; and up- 
on difTeftion it appears, that an elTufion of. 
blood had happened. This, I think, is 
to be confidered as a caufe of death, not 
as a caufe of the difeafe ; for in fuch cafes, 
I fuppofe that the difeafe had diminilh- 
ed the a6lion of the vefTels of the brain, 
and thereby given occafion to a ftagnation,' 



"which produced the appearances mentioned. 
And I apprehend the fame reafoning will ap;- 
ply to the cafes of retrocedcnt gout, which, 
by deflroying the energy of the brain, may 
occafion fuch a ftagnation as will produce 
rupture, efFufion, and death ; and in fuch a 
cafe, the appearances upon difle6lion might 
lead us to think that the apoplexy had de- 
pended entirely upon compreffion. 


The fevei-al caufes mentioned in MCXV, 
are often of fuch power as to occafion imme- 
diate death ; and therefore have not com- 
monly been taken notice of as affording in- 
ftances of apoplexy ; but, as the operation of 
the whole of thefe caufes is fimilar and anal- 
ogous, and as in mofl inftances of the opera- 
tion of thefe caufes an apopleQic ftate is man- 
ifeflly produced, there can be little doubt in 
confidering moft of the inftances of their ef- 
fefts as cafes of apoplexy, and therefore fuch 
as fall properly under our confideration here. 


This difeafe of apoplexy is fometimes en- 
tirely recovered from ; but more frequently 
it ends in death, or in a hemiplegia. Even 
when an attack of the difeafe is recovered 
from, we generally find it difpofed to return ; 
-and the repeated attacks of it almoft always, 




fooner or later^ bring on the events we have 


The feveral events of this difeafCj in health, 
death, or another difeafe, may be expefted 
and forefeen from a confideration of the pre- 
difponent circumftances (MXCV) ; of the 
antecedent fymptoms (MXCVI) ; of the ex- 
citing caufes (MXCVI 1 1) ; of the violence 
and degree of the fymptoms when the difeafe 
has come on (MX CIV) ; of the duration of 
the difeafe ; and of the effefts of the reme- 
dies employed. 


From the great danger attending this dif- 
eafe when it Jhas come on (MCXXII), it will 
readily appearj that our care fhould be chief- 
ly dire6led to the prevention of it. This, I 
think, may be often done by avoiding the re- 
mote and exciting caufes ; and how this may 
be accomplifhed, will be obvious from the 
enumeration of thofe caufes given above 
(MXCVIII.j But it will alfo appear from 
what is faid above, that the prevention of this 
difeafe will efpecially depend upon obviating 
the predifponent caufe ; which, in mofl cafes, 
feems to be a plethoric ftate of the bloodvef- 
fels of the brain. This, I think, may be ob- 
viated by different means ; and, in the firft 



place, by a proper management of exercife 
and diet. 


The exercife ought to be fuch as may fup- 
^ort the perfpiration, without heating the 
body or hurrying refpiration ; and, therefore, 
commonly by fome mode of geftation. In 
perfons not liable to frequent fits of giddi- 
nefs, and who are accuftomed to riding on 
horfeback, this exercife is, of all others, the 
beft. Walking, and fome other modes of 
bodily exercife, may be employed with the 
l-eftri6lionsjuft now mentioned'; but in old 
men, and in men of corpulent habits, bodily 
exercife ought always to be very moderate. 


In perfons who pretty early in life fliow 
the predifpofition to apoplexy, it is probable 
that a low diet, with a good deal of exercife, 
might entirely prevent the difeafe ; but, in 
perfons who are advanced in life before they 
think of taking precautions^ and are at the 
fame time of a corpulent habit, which gen- 
erally fuppofes their having been accuftom- 
ed to full living, it might not be fafe to put 
them upon a low diet ; and it may be enough 
that their diet be rendered more moderate 
thanufual, efpecially with refped to animal 

food i 

3^4 P R A G T I C £ 

food ; and that, at fupper, fuch food fliould 
be abftained from altogether. 

In drinking, all heating liquors are to be 
abftained from, as much as former habits "will 
allow ; and the fmalleft approach to intoxi- 
cation is to be carefully fhunned. For ordi- 
nary draught, fmall beer is to be preferred to 
plain water, as the latter is more ready to oc- 
cafion coftivenefs, which in apopleftic hab- 
its is to be carefully avoided. The large uf'e 
of tobacco in any ftiape, may be hurtful ; and 
except in cafes where it has been accuftomed 
to occafion a copious excretion from the head, 
the interruption of which might not be fafe,' 
the ufe of tobacco fhould be avoided ; and 
even in the circumftance mentioned, where 
it TTiay be in fome meafure neceffary, the ufe 
of it fhould at leaft be rendered as moderate 
as poffible. 


Evacuations by ftool may certainly con- 
tribute to relieve the plethoric ftate of the 
veffels of the head ; and, upon an appear- 
ance of any unufual furgefcence in thefe^ 
purging will be very properly employed-: 
But, when no fuch turgefcence appears, the 
frequent repetition of large purging might 
weaken the body too much ; and, for pre- 
venting apoplexy, it may for the moft part 
be enough to keep the belly regular, and 
rather open, by gentle laxatives. In the 


OF P H Y S i C. 325 

fummer feafon, it may be ufeful to drink, ev- 
ery morning, of a gentle laxative mineral 
water, but never in large quantity. 


In the cafe of a plethoric ftate of the fyf- 
tem, it might be fuppofed that bloodletting 
would be the moft eflFeftual means of dimm- 
iihing the plethora, and of preventing its con- 
fequences : And, when an attack of apoplexy 
is immediately threatened, bloodletting is cer- 
tainly the remedy to be depended upon ; and 
blood Ihould be taken largely, if it can be 
done, from the jugular vein, or temporal ar- 
tery. But, when no threatening turgefccnce 
appears, the obviating plethora is not ju- 
dicioufly attempted by bloodletting, as we 
have endeavoured to demonftrate above^ 
DCCLXXXVII. In doubtful circum- 
ftauces, leeches applied to the temples, or 
fcarifications of the hind head,,raay be more 
fafe than general bleedings. 


When there are iHanifeft fymptoms of a 
plethoric (late in the veffels of the head, a fe- 
ton, or pea ilTue, near the head, may be very 
ufeful in obviating any turgefcence of the 




Thefe are the means to be employed for pre'*, 
venting the apoplexy whith might arife from 
a plethoric ftate of the \^eflels of the brain ; 
and if, at the fame time, great care is taken to 
avoid the exciting caufes (MXCVIII), thefe 
means will be generally fnccefsful. 

In the cafes proceeding from other caufes 
(MCXV), as their application is fo imme- 
"diately fucceeded by tiie difeafe, they hardly 
allov/ any opportunity for prevention. 


For the Cure of apoplekies frotn internal 
caufes, and which I fuppofe to be chiefly 
thofe from compreffion, the ufual violence 
and fatality of it require that the proper rem-^ 
edies be immediately and largely employed. 

The patient is to be kept as much as pol- 
fible in fomewhat of an ereft poflure, and in 
cool air ; and therefore neither in a warm 
chaniber, nor covered with bed clothes, not 
furrounded with a crowd of people. 


In all cafes of a full habit, and where the 
difeafe has been preceded by marks of a ple- 
thoric ftate, bloodletting is to be immediately 
employed, and very largely. In my opin- 


O F P H Y S I C. 327 

ion, it will be moR efFeaual when the blood 
is taken from the jugular vein ; but, if that 
cannot be properly done, it may be taken 
from the arm. The opening of the temporal 
artery, when a large branch can be opened, 
fo as fuddenly to pour out a confiderable 
quantity of blood, may alfo be an efFeaual 
remedy ; but, in execution, it is more uncer- 
tain, and may be inconvenient. It may be 
infome meafure fupplied, by cupping and 
fcarifying on the temples or hind head. 
This,' indeed, ftiould feldom be omitted ; and 
thefe fcarifications are always preferable to 
the application of leeches. 

With refpeft to every mode of bloodlet- 
ting, this is to be obferved, that when in any 
cafe of apoplexy, it can be perceived that one 
fide of the body is more affected with the lofji 
of motion than the other, the bloodletting, if 
poflible, fhould be made on the fide oppofitc 
to that rnoft affe6led. 


Another remedy to be employed is purg- 
ing, to be immediately attempted by acrid 
glyfters ; and at the fame time, if any power 
of fwallowing remain, by draftic purgatives 
given by the mouth, Thefe, however, left 
-they may excite vomiting, fhould be given 
in divided portions at proper intervals. 



« Tp R A C T I C E 


Vomiting has been commended by fomc 
^raftitioners and writers : But, apprehending 
that this might impel the blood with too 
much violence into the veffels of the head, I 
have never emf)loyed it. 


Another remedy to be immediately em*. 
t)loyed is blifteringj and I judge that this is 
more effeftual when applied to the head, or 
near to it, than wheil it is applied to the low- 
er extremities. This remedy I do not con- 
fider as a flitnulant, or capable of making 
any confiderable revtilfion : Butj applied to 
the head, 1 fuppofe it ufeful in taking off the 
hemorrhagic difpofition fo often prevailing 


it has beeti ufual with praftitioners, to- 
gether with the remedies already mention- 
ed, to employ flimulants of various kinds : 
But I am difpofed to think them generally 
hurtful ; and they muft be foj wherever the 
fulnefs of the veffels^ and the impetus of the 
blood in thefe, is tb be diminiflied. Upon 
this principle it is therefore agreed, that flim- 
ulants are abfolutely improper in what is fup- 


Q F PHYSIC. 3129 

pofed to be a-fanguine apoplexy; but they 
are commonly fuppofed to be proper in the- 
ferous. If, however, we be right in alleging 
that this alfo commonly depends upon a ple- 
thoric ftate of the bloodveflels of the brain, 
ftimulants muft be equally improper in the 
one cafe as in the other. 


It may be argued from the almoll univerfal 
employment of ftimulants,, and fometimes 
with feeming advantage,, that they may not 
be fo hurtful as my notions of the caufes of 
apoplexy lead me to fuppofe. But this ar- 
gument is, in feveral refpefts, fallacious ; and 
particularly in this,^ that, in a difeafe which^ 
under every management, often proceeds, fo 
quickly to a fatal termination, the effeds of 
remedies are not to be eafily afcertained. 


I have now mentioned the feveral remedies 
which I think adapted to the cure of apo- 
plexy arifing from compreffion, and flaould 
next proceed to treat of the cure of apoplexy, 
arifmg from thofe caufes that dire€lly deftroy 
the mobility of the nervous power. But 
many of thofe caufes are often fo powerful, 
and thereby fo fuddenly fatal in their effeas^ 
as hardly to allow of time for the ufe of reni-- 
edies ; and fuch cafes therefore have been io 
p o leldom: 


fcldom the fubjefts of praftice, that the prop- 
er remedies are not io well alcertaincd as to 
enable me to fay much of them here. 


When, however, the application of the 
Gaufes (MCXV) is not fo powerful as imme- 
diately to kill, and induces only an apopleftic 
ftate, fome efforts are to be made to obviate 
the confequences, and to recover the patient ; 
and even in fome cafes where the caufes re- 
ferred to, from the ceafing of the pulfe and of 
refpiration, and from a coldnefs coming upon 
the body, have induced an appearance of 
death ; yet, if thefe appearances have not 
continued long, there may be means of re- 
covering the perfons to life and health. I 
cannot, indeed, treat this fubjeft completely ; 
but for the cure of apoplexy from leveral 
of the caufes mentioned MCXV, fliall offer 
the following general dire6lions. 

1. When a poifon capable of producing 
apoplexy has been recently taken into the 
ftomach, if a vomiting fpontaneoufly arifes, it 
is to be encouraged ; or, if it does not fpon- 
taneoufly come on, a vomiting is to be imme- 
diately excited by art, in order that the poifon 
may be thrown out as quickly as poflible. 
If, however, the poifon has been taken into 
the flomach long before its efFefts have ap- 
peared, we judge that, upon their appear- 

a F P H Y S'l C. 33.t. 

ance, the exciting of vomiting will iJe ufelefex 
and may perhaps be hurtful. • '* 

2. When the poifon taken' iiito the fiomi 
ach, or othervvife applied to the body, hasaT- 
ready induced an apopleftic Hate, as thofe 
caufcs do commonly at the fame time occa- 
fion a ftagnation or flawer motion of the 
blood in the vefTels-of the brain and of the 
lungs, fo it will generally be proper to, relieve 
this congeftion by taking fome blood from 
the jugular vein, or from, the veins- of the 

3. Upon the fame fuppofition of a con- 
geftion in the brain or lungs, it will generally 
be proper to relieve it by means of acrid 
clyflers producingforae evacuation from the 

4. When thefe evacuations by bloodletting 
and purging have been made, the various 
flimulants which hav* been commonly pro- 
pofed in other cafes of apoplexy, may be em- 
ployed here with more probability and fafe- 
ty. One of the moft efFedual means of 
roufing apoplectics of this kind feems to 
be throwing cold water on feveral parts of 
the body, or wafhing the body all over with 

5. Although the poifon producing apo- 
plexy happens to be fo powerful as very foon 
to occafion the appearances of death above 
mentioned ; yet if this Hate has not contin- 
ued long, the patient may often be recover- 
able ; and the recovery is to be attempted 

F4' by 


by the fame means that are direfted to 
be employed for the recovery of drowned 
perfons, and which are now commonly 


a F p H Y 3 I c. sat 


OF palsy: 


Palsy is a difeafc confift- 
jng in a lofs of the power of voluntary mo- 
tion, but afFeding certain parts of the body 
only, and by this it is diftinguiftied from ap- 
oplexy (MXCIV). One of the moft fre- 
quent forms of palfy is when it affeas the 
whole of the mufcles on one fide of the 
body ; and then the difeafe is named a He- 


The Ibfs of the power of vokmtary motion 
itjay be owing either to a morbid affe6lion of 
the mufcles or organs of motion, by which they 
are rendered unfit for motion ; or to an mter- 
Tuption of the influx of the nervous power m- 

Vcou 2. P 5 ^^ 


to them, which is alwa)'s neceflary to the mo, 
(ions of thole tliat are under the power of 
the will. The difeafe, from the firfl of thefe 
( nufes, as confifting in an organic and local 
affetlion, we refer entirely to the clafs of lo- 
cal difcafes. I am here to confider that dif- 
eafe only which depends upon the interrupt- 
ed influx of the nervous power ; and it is to 
this difeafe alone I would give the appella- 
tion of Paljy. A difeafe depending on an 
interrupted influx of the nervous power, may 
indeed often appear as merely a local affec- 
tion ; but as it depends upon an affeftion of 
the mod general powers of the fyflem, it 
cahnot be properly feparated from the fyfle- 
matic affe£lions» 


In pal fy, the lofs of motion is often ac- 
companied with a lofs of fenfe : But as this 
IS not conflantly the cafe, and as therefore the 
lofs of fenfe is not an effential fymptom of 
palfy, 1 have not taken it into my definition 
(MCXL) ; and I fhall not think it neceffary 
to take any further notice of it in this treatife ; 
becaufe, in fo far as it is in any cafe a part of 
the paralytic a£Fe£lion, it mufl depend upon 
the fame caufes, and will be cured alfo by the 
very fame remedies, as the lofs of motion. 




The palfy then, or lofs of motion, which 
is to be treated of here, may be diftinguiilied 
as of two kinds ; one of them depending up- 
on an afFcftion of the origin of the nerves in 
the brain, and the. other depending upon an 
aflFedlion of the nerves in fome part of their 
courfe between the. brain .and the organs of 
motion. Of the latter, as appearing in a very 
partial affeftion, I am not to fpeak particu- 
larly here ; I, fhall only treat of the more 
general paralytic afFe6lions, and efpecially of 
the hemiplegia (MCXL). At the fame time 
I expeft, that what I fhall fay upon this fub- 
jeft will readily apply to both the pathology 
and pra£lice in. the cafes of affefitions more . 


The hemiplegia (MCXL) ufually begins 
with, or follows, a paroxyfm of apoplexy ; 
and when the hemiplegia,-after fubfifting for 
fome time, becomes fatal, it is commonly by 
pafling again imo the ftate of apoplexy. The 
relation therefore or affinity between the two 
difeafes, is fuffioiently evident ; and is further 
Itrongly confirmed by this, that the herpi- 
plegia comes upon perfons of the fame con- 
ftitution (MXCV), and is preceded by the 
p 6 lame 


fame fyrnptoms (MXCVIII), that have been 
t.ikcn notice of with refpeft to apoplexy. 


When a fit of apoplexy has gone off, and 
there remains a Hate of palfy appearing as a 
partial afFcftion only, it might perhaps be 
fuppofed that the origin of the nerves is in a 
great meafure relieved ; but in fo far as com- 
monly there ftill remain the fyrnptoms of the 
lofs of memory, and of fome degree of fatu- 
ity, thefe, I think, {how that the organ of in- 
telleft, or the common origin of the nerves, 
is ftill confiderably aflFe6led. 


Thus, the hemiplegia, from its evident 
connexion with, and near relation to apo- 
plexy, may be properly confidered as de- 
pending upon like caufes ; and confequently, 
either upon a compreflion preventing the 
flow of the nervous power from the brain in- 
to the organs of motion, or upon the applica- 
tion of narcotic or other powers (MCXV) 
rendering the nervous power unfit to flow in 
the ufual and proper manner. 


We begin with confidering the cafes de- 
pending upon compjeflion. 



The compreflion occafioning hemiplegia 
may be of the Tame kind, and of all the dif- 
ferent kinds that produce apoplexy ; and 
therefore either from tumour, over diftention, 
or efTufion. The exiftence of tumour giving 
comprellion, may often be better difcerned in 
the cafe of palfy than in that of apoplexy, as 
its efFeds often appear at firft in a very par- 
tial aflfe6lion. 


The other modes of compreflion, that is, of 
over diftention and efFufion, may, and com- 
monly do, take place, in hemiplegia j and 
when they do, their operation here differs 
from that producing apoplexy, by its effefts 
being partial, and on one fide of the body 

It may feem difficult to conceive that an 
over diftention can take place in the veflels 
on one fide of the brain only ; but it may be 
underftood : And in the cafe of a palfy 
which is both partial and tranfitory, it is per- 
haps the only condition of the veflels of the 
brain that can be fuppofed. In a hemiple- 
gia, indeed, which fubfifts for any length of 
time, there is probably always an effufion, 
either fanguine or ferous : But it is likely that 
even the latter muft be fupported by a re- 
maining congeftion in the bloodveffels. 




That a fanguine effufion can happen with 
out becoming very foon general, and thereby 
occafioning apoplexy and death, may alto 
feem doubtful : But diire6lions prove that in 
fafcl it does happen occahoning palfy only ; 
though it is true, that this more commonly 
depends upon an effufion of ferous fluid, and 
of this only. 


Gan a palfy occafioned by a comprefi 
fion remain, though the comprelhon be re- 
moved ? 


From what has been faid MCXLIV, it 
will be obvious, that the hemiplegia may be 
prevented by all the feveral means propofed 
MCXXV etfeq. for the prevention of apo- 


Upon the fame grounds, the Cure of paU 
fy muft be very much the fame with that of 
apoplexy (MCXXX et feq.) ; and when 
palfy has begun as an apoplexy, it is prefum- 
ed, that, before it is to be confidered as palfy, 


O F P II Y S I C. 339 

all thofe feveral remedies have been employ- 
ed Indeed, even when it happens that on 
the fira attack of the difeafe the apopkaic 
Rate is not very complete, and that the very 
fira appearance of the difeafe is as a hemi- 
plegia, the affinity between the two difeales- 
JmCXLIV) is fuch as to lead to the fame 
remedies in both cafes. This is certamiy 
proper in all thofe cafes in which we can with 
much probability impute the difeafe to com« 
preffion ; and it is indeed feldom that a 
hemiplegia from internal caufes comes on but 
with a confiderable afFeaion of the internal 
and even of the external fenfes, together with 
other marks of a comprefTiou of the origin, ot 
the nerves. 


Not only, however, where the difeafe can 
be imputed to compreflion, but even where 
it can be imputed to the application of nar- 
cotic powers, if the difeafe come on with 
the appearances mentioned at the end of lalt 
paragraph, it is to be treated in the fame 
manner as an apoplexy by MCXXXI 



The cure of hemiplegia, therefore, on its 
fira attack, is the lame, or very nearly the 


3:40 p r: a c t I c e 

fame, with that of apoplexy : And it fecms 
requifite that it ffiould be different only, i 
When the diieafe -has fubfifted for fome 
time; 2. When the apoplcaic fymptoms, or 
thofe marking a confiderable compreffion of 
the origin of the nerves, are removed ; and 
particularly, 3. When there are no evident- 
marks of compreffion, and it is at the fame 
tmie known that narcotise powers have beext. 


.xr? t. '^ ^^^^^* ^^^ queftion arifes^ 

Whether ftimulants may be employed, or 
how far the cure may be entirely trufted to 
fuch remedies ? Upon this queftion, with 
refpea to apoplexy, I have oflPered my opin- 
ion in MCXXXVI. And, with refped to 
hemiplegia, I am of opinion, that ftimulants 
are almoft always equally dangerous as in the 
cafes of complete apoplexy ; and^ particular- 
ly, 1. In all the cafes of hemiplegia fucceed- 
mg to a paroxyfm of complete apoplexy ; 2. 
In all the cafes coming upon perfons of the 
temperament mentioned in MXCV, and after 

5^^/t"?fr^''"^^'^^^^''^' ^' ^^°^e of apoplexy 
(iMCXVI); and, 3. In all the cafes coming 
on witn fymptoms of apoplexy from com- 




It is, therefore, in the cafes MCLIV only, 
that ftimulants are properly admiffible : And 
even in the two firll of thefe cafes, in which a 
plethoric ftate of the bloodveflels of the brain 
may have brought on the difeafe, in which a 
difpofition to that ftate may ftill continue, and 
in which even fome degree of congeftion may 
ftill remain, the ufe of ftimulants muft be- 
an ambiguous remedy ; fo that perhaps it is 
in the third of thefe cafes only that ftimulants 
are clearly indicated and admiflible. 


Thefe doubts with refpeft to the ufe of 
ftimulants, may. perhaps be overlooked or 
difregarded by thofe who allege that ftimu- 
lants have been employed with advantage 
even in thofe cafes (MCLV) in which I have 
faid they ought to be avoided. 


To compromife this contrariety of opinion, 
I muft obferve, that even in the cafes of hemi- 
plegia depending upon compreflion, although 
the origin of the nerves be fo much comprelT- 
ed as to prevent fo full a flow of the nervous 
power as is neceflary to mufcular motion, yet 



it appears from the power of fenfe ft ill re- 
maining-, that the nerves are, to a certain de- 
gree, ftill pervious ; and therefore it is pol- 
fible that ftimulants applied, may excite the 
energy of the brain fo much, as in fome mcaf- 
urc to force open the comprelTed nerves, and 
to fhow fome return of motion in paralytic 
mufcles. Nav, further, it may be allowed, 
that if thefe ftimulants be fuch as aft more 
upon the nervous than upon the fanguiferous 
fyftem, they may poflibly be employed with- 
out any very hurtful confequence. 


But ftill it will be obvious, that although 
certain ftimulants a6l_chiefly upon the ner- 
vous fyftem, yet they alfo aft always in fome 
meafure upon the fanguiferous ; fo that, when 
they happen to have the latter efFeft in any 
confiderable degree, they may certainly do 
much harm ; and in a difeafe which they do 
not entirely cure, the mifchief arifmg from- 
them may not be difcerned. 


Whilft the employment of ftimulants is fo-- 
often an ambiguous praftice, we may perhaps 
go fome length towards afcertaining the mat- 
ter, by confidering the, nature of the feverai' 
ftimulants which may be employed, and fome. 
- o£- 


of the circumftances of their adminiftration. 
With this vievvT, therefore, I fhall now men- 
tion the feveral ftimulants that have been 
commonly employed, and offer fome remarks 
upon their nature and ufe. 


They are in the firft place to be diflin- 
guifhed as external or internal. Of the firft 
kind, we again diftinguifh them as they are 
applied to particular parts of the body only, 
or as they are more generally applied to the 
whole fyftem. Of the firfl kind are, 

1. The concentrated acids of vitriol or ni- 
tre ; involved, however, in oily or unfluous 
fubftances, which may obviate their cor- 
rofive, without deftroying their ftimulant 

2. The volatile alkaline fpirits, efpecially 
in their cauftic ftate ; but involved alfo iri 
oils for the purpofe juft now mentioned. 

3'. The fame volatile fpirits are frequently 
emploved by being held to the nofe, when 
■ they prove a powerful llimulus to the nervous 
fyftem ; but it is at the fame time probable, 
that they may alfo prove a ftrong ftimulant 
to the bloodveflels of the brain. 

4. A brine, or ftrong folution of fea fait. 

5. The eflential oils of aromatic plants, or 
of their parts. , - 

6. The eflential oils of turpentine, or or 
other fuch reGnous fubftances. ^^^ 


7. The diftilled oils of amber, or of other 
bituminous foflils. 

8. The re£lified empyreumatic oils of an- 
imal or vegetable fubftances. 

9. Various vegetable acrids, particularly 

10. The acrid matter found in feveral in- 
fers, particularly cantharides. 

Some of thefe flimulants may be either ap- 
plied in fubftance ; or may be diffolved in 
ardent fpirits, by which their ftimulant pow- 
er may be increafed, or more conveniently 


The greater part of the fubftances now 
enumerated Ihow their ftimulant power by 
inflaming the flcin of the part to which they 
are applied j and when their application is 
fo long continued as to produce this effea. 
It interrupts the continuance of their ufe j 
and the inflammation of the part does not 
feem to do fo much good as the frequent 
repetition of a more moderate ftimulus. 


Analogous to thefe ftimulants is the fting- 
mg of nettles, which has been frequently 

Among the external ftimulants, the me- 
chanical one of friftion with the naked hand, 



ihe flefli brufh, or flannel, is juftly to be 
reckoned. Can the impregnation of the 
flannels to be employed, with the fumes of 
burning maftic, olibanum. Sec, be of any 
fervice ? 


With refpeft to the whole of thefe external 
"flimulants, it is to be obferved, that they af- 
feft the part to which they are applied much 
more than they do the whole fyftem, and 
they are therefore indeed fafer in ambiguous 
cafes ; but, for the fame reafon, they are of 
lefs efficacy in curing a general affeftion. 


The external applications which may be 
applied to aff^eft the whole fyftem, are the 
powers of heat and cold, and of ele6lricity. 

Heat, as one of the mofl; powerful ftimu- 
lants of the animal economy, has been often 
employed in palfies, efpecially by warm bath- 
ing. But as, both by ftimulating the folids 
and rarefying the fluids, this proves a ftrong 
ftimulus to the fattguiferous fyftem, it is often 
an ambiguous remedy i and has frequently 
been manifeftly hurtful in palfies depending 
upon a congeftion of blood in the veffels of 
the brain. The moft certain, and therefore 
the moft proper ufe of warm bathing in pal- 
fies, feems to be in thofe that have been oc- 



cafioned by the application of narcotic pow- 
er^. Are the natural baths more uieful by 
the matters with which they may be naturally 
impregnated ? 


Cold applied to the body for any length 
of time, is always hurtful to paralytic per- 
fbns ; but if it be not very intenfe, nor the 
application long continued, and if at the fame 
time the body be capable of a briflc reaflion, 
fuch an application of cold is a powerful 
ftimulant of the whole fyflem, and has often 
heGn ufeful in curing palfy. But, if the 
power of reaftion in the body be weak, any 
application of cold may prove very hurtful. 


Ele6lricity, in a certain manner applied, is 
certainly one of the moft powerful ftimulants 
that can be employed to a£l upon the ner- 
vous fyftem of animals ; and therefore much 
has been expe£led from it in the cure of pal- 
fy. But, as it flimulates the fanguiferous as 
well as the nervous fyftem, it has been often 
hurtful in palfies depending upon a compref- 
fion of the brain ; and efpecially when it has 
been fo applied as to aft upon the vejTels of 
the head. It is fafer when its operation is 
confined to particular parts fomcwhat remote 
from the head j and, further, as the operation 


OF P H V S .1 -C. '347 

of ele£lricity, when very flrong, can deflroy 
the mobility of the nervous poKcr, I am. of 
opinion, that it is always to be employed with 
caution, and that it is only fafe when applied 
with moderate force, and when confined to 
certain parts of the body remote from the 
head. It is alfo my opinion,, that its good 
ctFe6ls are to be expefted from its repetition 
rather than from its force, and that it is par- 
ticularly fuited fo the cure of thofe palfie-s 
which have been produced by the application 
of narcotic powers. 


Amongft the remedies of palfy, the uffe 6( 
exercife is not to be omitted. In a hemiple- 
gia, bodily exercife cannot be employed ; and 
in a more limited afFe6tion, if depending up- 
on a compreflion of fome part of the brain, it 
would be an ambiguous remedy : But, in all 
cafes where the exercifes of geftation can be 
employed, they^ are proper j as, even in cafes 
of compreffion, the flimulus of fuch exercife 
is moderate, and therefore fafe ; and, as it al- 
ways determines to the furface of the body, it 
is a remedy in all cafes of internal congeflion. 


^ \ The internal flimulants employed in palfy 
^LXt various, but chiefly the following. 
' ' 1. The 


1. The volatile alkaline falts, or fpirits, as 
they are called, are very powerful and difFu- 
five ftimulants, operating efpecially on the 
nervous fyilem ; and even although they op- 
erate on the fanguiferous, yet, if given in fre- 
quently repeated fmall rather than in large 
dofes, their operation being tranfitory, is tol- 
erably fafe. 

2. The vegetables of the clafs named Te- 
tradynamia, are many of them powerful dif- 
fufive ftimulants ; and at the fame time, as 
quickly paffing out of the body, and therefore 
of tranfitory operation, they are often em- 
ployed with fafety. As the)r commonly prove 
diuretic, they may in this way alfo be of fer- 
vice in fome cafes of ferous palfy. 

3. The various aromatics, whether em.- 
ployed in fubflance, in tin6lure, or in their 
effential oils, are often poweaful ftimulants ; 
but being more adhefive and inflammatory 
than thofe laft mentioned, they are therefore, 
in all ambiguous cafes, lefs fafe. 

4. Some other acrid vegetables have been 
employed ; but we are not well acquainted 
with their peculiar virtues, or proper ufe. 

5. Some refinous fubftances, as guaiacum, 
and the terebinthinate fubftances, or their ef- 
fential oils, have been, with fome probability, 
employed ; but they are apt to become in- 
flammatory. Deco€lions of guaiacum, and 
fome other fudorifics, have been direfted to 
excite fweating by the application of the 
fumes of burning fpirit of wune in the la- 


O F' P H Y S I C. 349 

conicum, and have in that way been found 

6. Many of the fetid antifpafmodic medi- 
cines have been frequently employed in pal- 
fy ; but I do not perceive in what manner 
they are adapted to the cure of this difeafe, 
and I have not obferved their good effefts in 
any cafes of it. 

7. Bitters, and the Peruvian bark, have 
alfo been employed ; but with no propriety 
or advantage that I can perceive. 


With refpeCl to the whole of thefe internal 
flimulants, it is to be obferved, that they fel- 
dom prove very powerful ; and wherever 
there is any doubt concerning the nature or 
ftate of the difeafe, they may readily do 
harm, and are often therefore of ambiguous 

Vol. II. Q BOOK 


B o o }i 









1 HIS is a difeafe in whicfe 
the aftion of the heart and refpiration be- 
come conliderably weaker than ufual, or in 
which for a certain time thefe funftions ceafe 




t*hyficians having obferved that this affec- 
tion occurs in different degrees, have endeav- 
oured to diflinguifli thefe by different appel- 
lations : But as it is not pollible to afcertain 
thefe different degrees with any precifion, fo 
there can be no ftri6l propriety in employing 
thofe different names ; and I fliall here com- 
prehend the whole of the affeftions pf this 
kind under the title of Sync<!>pet 


This difeafe fometimes comes on fuddenly 
to a confiderable degree, but fometimes alfo 
it comes on gradually ; and in the latter cafe, 
it ufually comes on with a fenfe of languor, 
and of anxiety about the heart, accompanied 
at the fame time, or immediately after, with 
fome giddinefs, dimnefs of fight, atid found- 
ing in the ears. Together with thefe fymp- 
toms, the pulfe and refpiration become iveak ; 
iand often fo weak, that the pulfe is fcarcely 
to be felt, or the refpiration to be perceived ; 
End fometimes thefe motionsj for a certain 
time, ceafe altogether. While thefe fymp- 
toms take place, the face and whole furface of 
ithe body become pale, and more or lefs cold 
•'according to the degree and duration of the 
paroxyfm. Very commonly, at the begin- 
ning of this, and during its continuance, a 
Q 2 cold 


cold fweat appears, and perhaps continues, 
on the forehead, as well as on fome other 
parts of the body. During the paroxyfm, 
the animal funftions, both of fenfe and mo- 
tion, are always in fome degree impaired, and 
very often entirely fufpended. A paroxyfm 
of fyncope is often, after fome time, fponta- 
neoufly recovered from ; and this recovery 
is generally attended with a fenfe of mucfj 
anxiety about the heart. 

Fits of fyncope are frequently attended 
with, or end in, vomiting j and fometime* 
with convulfions, or an epileptic fit. 


Thefe are the phenomena in this difeafe ; 
and from every view of the greatefl part qi 
them, there cannot be a doubt that the prox- 
imate caufe of this difeafe is a very weak or a 
total ceafing of the aftion of the heart. But 
it will be a very difficult matter to explain in 
what manner the feveral remote caufes ope- 
rate in producing the proximate caufe. This, 
however, I fliall attempt, though with that 
diffidence which becomes me in attempting a 
fubje£l that has not hithertp been treated with 
much fuccefs. 


The remote caufe of fyncope may, in the 
firft place, be referred to two general heads. 



The one is, of thofe caufes exifling and aft- 
ing in the brain, or in parts of the body re- 
mote from the heart, but afting upon it by 
the intervention of the brain. The other 
general head of the remote caufes of fyncope, 
is of thofe exifling in the heart itfcif, or in 
parts very immediately conne6led with it, and 
thereby afting more direftly upon it in pro- 
ducing this difeafe. 


In entering unon tha confideration of the 
firft fet of thofe caufes (MCLXXIV), I muft 
aflfume a propofition which I fuppofe to be 
ftiJly eflabliflied in Phyfiology. It is this : 
That, though the mufcular fibres of the heart 
be endowed with a certain degree of inherent 
po-wer, they are dill, for fuch aftion as is nec- 
clfary to the motion of the blood, very con- 
ftantly dependent upon a nervous power fent 
into them from the brain. At lead this is 
evident, that there are certain powers a6ling 
|)rimarily, and perhaps only in the brain, 
which influence and varioufly modify the ac- 
tion of the heart. I fuppofe, therefore, a 
force very conftantly during life exerted in 
the brain, with refpeft to the moving fibres 
of the heart, as well as of every part of the 
body ; which force I fhall call the Energy of 
the Brain 1 and which I fuppofe may be, on 
O 3 different 


different occafions, ftronger or weaker witb 
refpeft to the heart. 


Admitting thefe propofitions, it will be ob- 
vious, that if I can explain in what manner 
the firfl fet of remote caufes (MCLXXIV) 
diminifti the energy of the brain, I fhall at the 
fame time explain in what manner thefe cauf-' 
es occafion a fyncope. 


To do this, I obferye, that one of the moft 
evident of the remote caufes of fyncope is a 
hemorrhagy, or an evacuation of blood, 
whether fpontaneous or artificial. And as it 
is very manifeft that the energy of the brain 
depends upon a certain fulnefs and tenfion of 
its bloodveffels, for w^hich nature feems to 
have induftrioufly provided by fuch a con- 
formation of thofe bloodveffels as retards the 
motion of the blood both in the arteries and 
veins of the brain ; fo we can readily per- 
ceive, that evacuations of blood, by taking off 
the fulnefs and tenfion of the bloodveffels of 
the brain, and thereby diminilhing its energy 
with refpeft to the heart, may occafion a fyn- 
cope. In many perfons, a fmall evacuation 
of blood will have this effeft ; and in fuch 
cafes there is often a clear proof of the man- 
ner in which the caufe operates, from this cir- 


OF P H Y S I C. 3^5; 

cumftance, that the efFeft can be prevented' 
by laying the body in a horizontal pofture ; 
which, by favouring the afflux of the blo6cl 
by the arteries, and retarding- the return of it 
by the veins, preferves the necclfary fubieis 
of the veffels of the brain. 

It is farther to be remarked here, that not 
only an evacuation of blood occalions fyn^. 
cope, but that even a change in the diftribu- 
tion of the blood, whereby a larger portion of 
it flows into one part of the fyftem of bloods- 
veflels, and confequently lefs into others^ may 
occafion a fyncope. It is thus L explain the 
fyncope that readily occurs upon, the evacu- 
ation of hydropic waters, which had before 
filled the cavities of the abdomen, or thorax. 
It is thus alfo I explain the fyncope that 
fometimes happens on bloodletting, but whicH 
does not happen till the ligature which had 
been employed is untied,. and admits a largej- 
afflux of blood into the bloodveflels of the 
arm. Both thefe cafes of fyncope fhow, that 
an evacuation of blood does not always occa- 
fion the difeafe by any general elFeft on the 
whole fyftem^, but often merely by taking ofT. 
tJie requilite fulnefs of the bloodveflels of the 


The operation of fome others of ths remote- 

caufes of fyncope, mav be explained on the. 

following principles. ' Whilft the energy of 

O 4 t^e: 


the brain is, upon different occafions, mani- 
feftly ftronger or weaker, it feems to be with 
this condition, that a ftronger exertion of it is 
neceffarily followed by a M'eaker (late of the 
fame. It feems to depend upon this law in 
the conftitution of the nervous power, that 
the ordinary contraftion of a mufcle is always 
alternated with a relaxation of the fame ; that, 
unlefs a contraftion proceeds to the degree of 
fpafm, the contrafted ftate cannot be long 
continued : And it feems to depend upon 
the fame caufe that the voluntary motions, 
which always require an unufual increafe of 
exertion, occafion fatigue, debility, and at 
length irrcfiflible fleep. 

From this law, therefore, of the nervous 
power, we may underftand, why a fudden 
and violent exertion of the energy of the 
brain is fometimes followed by fuch a dimi- 
nution of it as to occafion a fyncope ; and it 
is thus I fuppofe that a violent fit of joy pro- 
duces fyncope, and even death. It is upon 
the fame principle alfo, I fuppofe, that an ex- 
quifite pain may fometimes excite the energy 
of the brain more ftrohgly than can be fup- 
ported, and is therefore followed by fuch a 
diminution as muft occafion fainting. But 
the effeft of this principle appears more clear- 
ly in this, that a fainting readily happens up- 
on the fudden remillion of a confiderable 
pain J and thus I have feen a fainting occur 
upon the reduftion of a painful diflocation, 




It feems to be quite analogous when a fyn- 
cope immediately happens on the finilhing of 
any great and long continued effort, whether 
depending on the will, or upon a propenfity ;, 
and in this way a fainting fometimes happens 
to a woman on the bearing of a child. This 
may be well illuilrated by obferving, that iu 
perfons already much weakened, even a very 
moderate effort will fometimes occafiou faints 


To explain the operation of fome other 
caufes of fyncope, it may be obferved, that as 
the exertions of the energy of the brain are 
efpecially under the influence of the will, fo 
it is well known that thofe modifications of 
the will which are named Paflions and Emo- 
tions, have a powerful influence on the ener- 
gy of the brain in its anions upon the hearty 
either in increafmg or diminilhing the force 
of that energy. Thus, anger has the former, 
and fear the latter effe6l ; and thence it may 
be undcrflood how terror often occafions a 
fyncope fometimes of the mofl; violent kind, 
named Afphyxia, and fometimes death itfelf. 

Vol. 2. O 5 MCLXXXL 



As, from what I have jufl; mentioned, it 
appears, that the emotions of defire increafe, 
and thofe of averfion diminifh, the energy of 
the brain ; fo it may be underftood, how a 
flrong averfion, a horror, or the feeHng which 
arifes upon the fight of a very difagreeable ob- 
je6l, may occafion fainting. As an example 
of this, I have known more than one inftance 
of a perfon's fainting at the fight of a fore in 
another perfon. 


To this head of horror and difguft, I refer 
the operation of thofe odours which in certain 
perfons occafion fyncope. It may be fup- 
pofed, that thofe odours are endowed with a 
dire6lly fedative power, and may thereby oc- 
cafion fyncope ; but they are, many of them, 
with refpeft to other perfons, evidently of a 
contrary quality : And it appears to me, that 
thofe odours occafion fyncope only in thofe 
perfons to whom they are extremely difa- 


It is, however, very probable, that among 
the caufcs of fyncope, there are fome which» 
analogous to all thofe we have already men- 

OF- FITT S 1 C. 359. 

tk)ned,.a6l by a direcll)' fcdative power : And" 
fuch may either be diffufed in the mafs o*- 
blood, and thereby communicated to thfj 
brain ; or may be only taken into the ftom- 
ach, which I"o readily and frequently coramu*- 
nicates its affetlions to the brain. 


Having now enumerated, and, as I hopc^ 
explained, the mofl part of the remote caules 
of fyncope, that either operate immediately 
upon the brain, or whofe operation upon 
other parts of the body is communicated to 
the brain, it is proper to obferve,. that the 
mofl part of thefe caufes operate upon certain 
perfons more readily and more powerfully 
than upon others ; and this circumilancCj, 
which may be confidered as the predifponer* 
caufe of fyncope, deierves to be inquired 

It is, in the firfl place, obvious, that the 
operation of fome of thofe caufes depends en- 
tirely upon an idiofyncrafy in the perfons 
upon whom they operate j which, however, 
I cannot pretend to explain. But, in the 
next place, with refpe6l to the greater part of 
tiie other caufes, their effefts feem to depend 
upon a temperament which is in one degree 
or other in common to many perfons. This 
temperament fccms to confiil in a great de- 
gree of fenfibility and mobility, arifmg from 
a flate of debility, fometimcs depending upQn 
Q 6 original 


original conformation, and fometimes pro- 
duced by accidental occurrences in the courfe 
of life. 


The fecond fet of the remote Caufes of fyn- 
cope (MCLXXIV), or thofe ading direaiy 
upon the heart itfelf, are certain organic af- 
ieclions of the heart itfelf, or of the parts im- 
mediately conneQed with it, particularly the 
great veflels which pour blood into or imme- 
diately receive it from the cavities of the 
heart. Thus a dilatation or aneurifm of the 
heart, a polypus in its cavities, abfceffes or 
ulcerations in its fubflance, a clofe adherence 
of the pericardium to the furface of the heart, 
aneurifms of the great veffels near to the 
heart, polypus in thefe, and oflifications in 
thefe or in the valves of the heart, are one or 
other of them conditions which, upon dilTec- 
tion, have been difcovered in thofe perfons 
who had before laboured under frequent 


It is obvious, that thefe conditions are all 
of them, either fuch as may, upon occafion, 
difturb the free and regular influx into, or 
the free egrefs of the blood from, the cavities 
of the heart ; or fuch as may otherv/ife dif- 
turb its regular a6lion, by fometimes inter- 


rupting it, or fometimes exciting it to more 
violent and convulfive a6lion. The latter is 
what is named the Palpitation of the Heart, 
and it commonly occurs in the fame perfons 
who are liable to fyncope. 


It is this, as I judge, that leads us to per- 
ceive in what manner thefe organic afFeftions 
of the heart and great veffels may occafion 
fyncope : For it may be fuppofed, that the 
violent exertions made in palpitations may 
either give occafion to an alternate great re- 
laxation (MCLX XVIII), or to a fpafmodic 
contraftion j and in either way fufpend the 
a£Hon of the heart, and occafion fyncope. It 
feems to me probable, that it is a fpafmodic 
contraftion of the heart th^t occafions the in- 
termiffion of the pulfe fo frequently accom- 
panying palpitation and fyncope. 


Though it frequently happens that palpi- 
tation and fyncope arife, as we have faid, from 
the organic afFeftions above mentioned, it is 
proper to obferve, that thefe difeafes, even 
when in a violent degree, do not always de- 
pend on fuch caufes afting direftly on the 
heart, but are often dependent on fome of 



thofe caufes which we have mentioned above 
as a6ling primarily on the brain. 


I have thus endeavoured to give the pa- 
thology of lyncope ; and of the cure I can 
treat very ftiortly. 

The cafes of fyncope depending on the 
fecond fet of caufes (MCLXXIV), and fidly 
recited inMCLXXXV, I fuppofe to be gen, 
erally incurable ; as our art, fo far as I know, 
has not yet taught us to cure any one of thofe 
feveral caufes of fyncope (MCLXXXV). 

The cafes of fyncope depending on the 
firfl fet of caufes (MCLXXIV), and whofe 
operation I have endeavoured to explain in 
MCLXXVII etfeq. I hold to be generally 
curable, either by avoiding the feveral occa- 
fional caufes there pointed out, or by corre£l- 
ing the predifponent caufes (MCLXXXIV). 
The latter, I think, may generally be done 
by conefting the debility or rhobility of the 
fyftem, by the means which I have already 
iad occaCon to point out in another place. 

C H A P, 






A WANT of appetite, a 
fqueamifhnefs, fometimes a vomiting, fudden 
and tranfient diftentions of the ftomach, eruc- 
tations of various kinds, heartburn, pains in 
the region of the ftomach, and a bound belly, 
are fymptoms which frequently concur in the 
fame perfon, and therefore may be prefumed 
to depend upon one and the fame proximate 
caufe. In both views, therefore they may_be 
confidered as forming one and the fame dif^ 
eafe to which we have given the appellation 
of Dyjpcpjia, fet at the head of this chapter. 


But as this difeafe is alfo frequently a fec- 
ondary and fympathic affeaion, fo the fymp- 
toms above mentioned are often joined wuh 


many others ; and this has given occafion to 
a very confufed and undetermined defcrip- 
tion of it, under the general title of Nervous 
Difeafes, or under that of Chronic Weaknefs. 
It is proper, however, to diftinguifh ; and I 
apprehend the fymptoms enumerated above 
are thofe effential to the idiopathic afPeftion 
I am now to treat of. 


It is indeed to be particularly obferved, 
that thefe fymptoms are often truly accojn- 
panied with a certain ftate of mind which 
may be confidered as a part of the idiopathic 
afFeftion : But I fhall take no further notice 
of this fymptom in the prefent chapter, as it 
will be fully and more properly confidered 
in the next, under the title of Hypochon- 


That there is a diflinft difeafe attended al- 
ways with the greater part of the above fymp- 
toms, is rendered very probable by this, that 
all thefe feveral fymptoms may arife from one 
and the fame caufe ; that is, from an imbe- 
cility, lofs of tone, and weaker aftion in the 
mufcular fibres of the ftomach : And I con- 
clude therefore, that this imbecility may be 
confidered as the proximate caule of the 



difeafe I am' to treat of under the name of 


The imbecility of the ftomach, and the 
confequent fymptoms (MCXC), may, how- 
ever, frequently depend upon fome organic 
afFedion of the ftomach itfelf, as tumour, 
ulcer, or fcirrhofity j or upon fome affeftion 
of other parts of the body communicated to 
the ftomach, as in gout, amenorrhoca, and 
fome others. In all thefe cafes, however, the 
dyfpeptic fymptoms are to be confadered as 
fecondary or fympathic afFe61ions, to be cur- 
ed only by curing the primary difeafe. Such 
fecondary and fympathic cafes cannot, in- 
deed, be treated of here : But as I prefumci 
that the imbecility of the ftomach may often 
take place without either any organic affeftion 
of this part, or any more primary aflPedion in 
any other part of the body ; fo I fuppofe and 
expe£l it will appear, from the confideration 
of the remote caufes, that the dyfpepfia may 
be often an idiopathic afFe6lion, and that it 
is therefore properly taken into the fyftem of 
methodical Nofology, and becomes the fub- 
jeft of our confideration here. 


There can be little doubt, that, in moft 

cafes, the weaker aaion of the mufcular fibres 

* or 

366 P R A C T I C E 

of the ftomach, is the mofl: frequent and chid 
caufe of the fymptoms mentioned in MCXC ; 
but I dare not maintain it to be the only: 
caufe of idiopathic dyfpepfia. There is,, 
pretty certainly, a peculiar fluid in the ftom-' 
ach of animals, or at leaft a peculiar quality 
in the fluids, that we know to be there, upon 
which the folution of the aliments taken into 
the flomach chiefly depends : And it is at the 
fame time probable, that the peculiar quality 
of the dilFolving or digefting fluids may be 
varioufly changed, or that their quantity may 
be, upon occafion, diminifli^d. It is there-, 
fore fufhciently probable, that a change in 
the quality or quantity of thcfe fluids may 
produce a confiderable diff^erence in the phe- 
nomena of digeflion, and particularly may 
give occafion to many of the morbid apptar-^ 
ances mentioned in MCXC. 


This feems to be very well founded, and 
points out another proximate caufe of dyf-; 
pepfia befide that we have already affigned t 
But, notwithflanding this, as the peculiar na- 
ture of the digeftive fluid, the changes which 
it may undergo, or the caufes by which it 
may be changed, are all matters fo litde 
known, that I cannot found any praftical 
doftrine upon any fuppofition with refpefl: 
to them ; and as, at the fame time, the imbe- 
cility of the flomach, either as caufing the 



change in the digeftive fluid, or as being irt- 
duccd by that change, feems always to be,- 
prefcnt, and to have a great Ihare in occafion- 
ing the fymptoms of indigeftion ; fo I fhall 
flill confider the imbecility of the ftomach as 
the proximate and almoft fole caufe of dyf- 
pepfia. And I more readily admit of this, 
manner of proceeding ; as, in my opinion, 
the doftrine applies very fully and clearly to 
the explaining the whole of the pradice which 
experience has eftabliftied as the moft fuccefs^ 
ful in this difeafe. 


Confidering this, then, as the proximate 
caufe of dyfpepfia, I proceed to mention the 
fever^l remote caufes of this difeafe ; as they 
are fuch, as, on different occafions, feem to 
produce a lofs of tone in the mufcular fibres 
of the flomach. They may, I think, be con- 
fide red under two heads. The firjl is, of 
thofe which ad diredly and immediately up- 
on the ftomach itfelf : Thtjecond is, of thofe 
which aa upon the whole body, or particular 
parts of it, but in confequence of which the 
ftomach is chiefly or almoft only affeaed. 


Of the lirft kind are, 

1. Certain fedativc or narcotic fubitances 
taken into the ftomach ; fuch as tea, cottee, 



tobacco, ardent fpirits, opium, bitter:?, aro^ 
matics, putrids, and acefcents. 

2. The large and frequent drinking of 
warm water, or of warm watery liquids, 

3. Frequent furfeit, or immoderate reple- 
tion of the llomach. 

4. Frequent vomiting, whether fpontane- 
oufly arifing, or excited by art. 

5. Very frequent fpitting, or rejeflion of 
fall V a. 


Thofe caufes which aft upon the whole 
body, or upon particular parts and funflions 
of it, are, 

1. An indolent and fedentary life. 

2. Vexation of mind, and diforderly paf- 
fions of any kind. 

3. Intenfe ftudy, or clofe application to 
bufinefs too long continued. 

4. Excefs in venery. 

5. Frequent intoxication ; which partly 
belongs to this head, partly to the former. 

6. The being much expofed to moift and 
cold air when without exercife. 

Though the difeafe, as proceeding from the 
laft fet of caufes, may be confidered as a 
fymptomatic affeftion only ; yet as the affec- 
tion of the ftomach is generally the firft, al- 
ways the chief, and often the only effed 
which thefe caufes produce or difcover, I 
think the affection of the ftomach may be 



confidered as the difeafe to be attended to in 
praftice ; and the more properly fo, as in 
jjnany cafes the general debility is only to be 
cured by reftoring the tone of the llomach, 
and by remedies firft applied to this organ, 


For the cure of this difeafe, we form three 
feveral indications ; a prefervative, a paliative, 
and a curative. 

Thejirjl is, to avoid or remove the remote 
caufes juft now enumerated. 

The fecond is, to remove thofe fymptoms 
which efpecially contribute to aggravate and 
continue the difeafe. And, 

The third is, to reftore the tone of the 
ftomach ; that is, to correfl: or remove the 
proximate caufe of the difeafe. 


The propriety and neceffity of the firft in- 
dication is fufficiently evident, as the contin- 
ued application, or frequent repetition of 
thofe caufes, muft continue the difeafe ; may 
defeat the ufe of remedies ; or, in fpite of 
thefe, may occafion the recurrence of the dif- 
eafe. It is commonly the negleft of this in- 
dication which renders this difeafe fo fre- 
quently obftinate. How the indication is to 
be executed, will be fufl&ciently obvious from 
the confideration of the fevejal caufes : But 



I» R A C T I C E 

it is proper for the pra^lrtioner to attend t6 
this, that the execution is often exceedingly 
difficult, becaufe it is not eafy to engage men 
to break in upon eftabHfhed habits, or to re*, 
nounce the purfuit of pleafure ; and pai'tic- 
iilarly, to perfuade men that thefe praftices 
are truly hurtful which they have often prac. 
tifed with feeming impunity. 


The fymptoms of this difeafe which efpcc*. 
ially contribute to aggravate and continue it, 
and therefore require to be more immediate- 
ly correfted or removed, are, firft, the crudi- 
ties of the fiomach already produced by the 
difeafe, and difcovered by a lofs of appetite, 
by a fenfe of weight and uneafinefs in the 
ftomach, and particularly by the eru6lation 
.of imperfeftly digefted matters. 

Another fymptom to be immediately cor- 
refted, is an unuFual quantity, or a higher 
degree than ufual, of acidity prefent in the 
fiomach, difcovered by various diforders in 
digeftion, and by other effe6ls to be men- 
tioned afterwards. 

The third fymptom aggravating the dif- 
eafe, and otherwife in itfelf urgent, is coflive- 
nefs, and therefore conflantly requiring to be 


Thtjirjl of thefe fymptoms is to be reKeV- 
ed -by exciting vomiting ; and the ufe of this 


•OF P H Y S I C. 371 

remedy, therefore, ufually and properly be* 
gins the cure of this difeafe. The vomiting 
may be excited by various means, more gen->. 
tie or more violeilt. The former may an-^. 
-fwer the purpofe of evacuating the contents 
of the ftomach : But emetics, and Vomiting, 
may alfo excite the ordinary aflion of the 
Itomach ; and both, by varioufly agitating 
■the fyllem, and particularly by determining 
to the furface of the body, may contribute to 
remove the caufes of the difeafe. But thefe 
latter efFe6ls can ohly be obtained by the 
ufe of emetics of the more powerful kind, 
fuch as the antimonial emeticis efpecially are. 


The feconi fymptom to be palliated, is an 
excefs of acidity, either in quantity or quali- 
ty, in the contents of the llomach. In man 
^here is a quantity of acefcent aliment almofl 
conllantly taken in, and, as I think, always 
undergoes an acetous fermentation in the 
ftomach ; and it is therefore that, in the hu- 
man ftomach, and in the ftomachs of all ani- 
mals ufing vegetable food, there is always 
found an acid prefent. This acid, however, 
is generally innocent, and occafiotis no difor- 
der, unlefs either the quantity of it is very 
large, or the acidity proceeds to a higher de- 
gree than ufual. But, in either of thefe cafes, 
the acid occafions various diforders, as flat- 
lUency, eru6lation, heartburn, gnawing pains 


of the ftotnach, irregular appetites and crav- 
ings, loofenefs, griping, emaciation, and debil- 
ity. To obviate or remove thefe effects ag- 
gravating and continuing the difeafe, it is not 
only neceilary to corre6l the acid prefent in 
the flomach ; but, efpecially as this acid 
proves a ferment determining and increafing 
the acefcency of the aliments afterwards taien 
in, it is proper alfo, as foon as poffible, to cor- 
reft the difpofition to exceflive acidity. 


The acidity prefent in the ftomach may be 
correfted by the ufe of alkaline falts, or ab- 
forbent earths ; or by fuch fubftances, con- 
taining thefe, as can be decompofed by the 
acid of the ftomach. Of the alkalines, the 
cauftic is more effeftual than the mild ; and 
this accounts for the efFefts of lime water. 
By employing abforbents, we avoid the excefs 
of alkali, which might fometimes take place. 
The abforbents are different, as they form a 
neutral more or lefs laxative ; and hence the 
difference between magnelia alba and other 
abforbents. It is to be obferved, that alka- 
lines and abforbents may be employed to ex- 
cefs ; as, when employed in large quantity^ 
they may deprive the animal fluids of the acid 
neceffary to their proper compolition. 


The difpofition to acidity may be obviat- 
ed by avoiding acefcent aliments, and ufing 


O J- PHYSIC. s;^ 

tfhimal food little capable of acefcency. IThi?, 
however, cannot be long continued without 
corrupting the flate of our blood ; and as veg- 
etable food cannot be entirely avoided, the 
excefs of their acefcency may in fome meaf* 
ure be avoided, by choofing vegetable food 
the leafl difpofed to a villous fermentation, 
fuch as leavened bread and well fermented 
liquors^ andi inflead of frefh native acids, em- 
ploying vinegar. 


The acid arifmg from acefcent rnattefs in a 
found ftate of the flomach, does not pr6ceed 
to any high degree^ or is again foon involved' 
and made to difappear : But this does not al- 
ways happen J and a more copious acidity, or 
a higher degree of it, may be produced, either 
from a change in the digeftive fluids, become 
lefs fit to moderate fermentation and to coyer 
acidity, or from their not being fupplied iti 
due quantity. How the fonuer may be oc- 
cJafioned, we do not well underftand ; but we 
tan readily perceive that the latter, perhaps 
the former alfo, may proceed from a v\^eaker 
a£lion of the mufcular fibres of the ftbmach. 
In certain cafes, fedative pafTions, irtimcdiately 
after they arife, occafioh the appealahce of 
acidity in the flomach which did not appear 
before ; and the ufe of ftimulants often cor- 
refts or obviates an acidity that would other- 
tv'ife have appeared. From thefe confidera- 
tions, we conclude, that the pfodu6liort and 
Tubfiflence of acidity in the flomach, is to be 
Vot. II. R -€fpecially 



efpecially prevented by refloring and exciting 
the proper a6lion of it, by the feveral means 
to be mentioned hereafter. 


But it is alfo to be further obferved, thac 
ihough there are certain powers in the flom- 
ach for preventing a too copious acidity, or a 
high degree c^it, they are not however ahvays 
fufficient for preventing acefcency, or for cbv- 
■ering the acidity produced ; and therefore, as 
long as vegetable fubftances remain in the 
ftomach, their acefcency may go on and in- 
creafe. From hence we perceive, that a fpec- 
ial caufe of the excefs of acidity may be, the 
too long retention of acefcent matters in the 
'ftomach ; whether this may be from thefe 
matters being of more difficult folution, or 
from 'the weaknefs of the ftomach more flow- 
ly difcharging its contents into the duodenum, 
or from fome impediment to the free evacu- 
ation of the ftomach by the pylorus. The 
latter of thefe caufes we are well acquainted 
with, in the cafe of a fcirrhous pylorus, pro- 
ducing commonly the higheft degree of acid- 
ity. In all the inftances of this fcirrhofity I 
have met with, I have found it incurable : 
But the firft of thefe caufes is to be obviated 
by avoiding fuch aliments as are of difficult 
folution ; and the fecond is to be mended by 
the feveral remedies for exciting the aftion of 
the ftomach, to be mentioned afterwards. 




The third fymptom commonly aGCompa^. 
nying dyfpepfia, which requires to be imme- 
diately removed, is coftivenefs. There is fo 
much connexion between the feveral portions 
of the alimentary canal with refpe6l to the pe- 
riftaltic motion, that, if accelerated or retard- 
ed in any one part, the other parts of it are 
commonly afFeded in the fame manner. Thus, 
as the brifker a6lion of the flomach mull ac- 
celerate the aftion of the inteflines, fo the 
flower aftron of the inteftines muft in fome 
meafure retard that of the flomach. It i.s 
therefore of confequence to the proper a6lion 
of the ftomach, that the peri ftal tic motion of the 
inteftines determining their contents down- 
wards, be regularly continued ; and that all 
coftivenefs, or interruption of that determina- 
tion, be avoided. This may be done by the 
various means of exciting the a6lion of the in- 
teftines : But it is to be obferved here, that as 
every confiderable evacuation of the inteftines 
weakens their a£lion, and is read)^ therefore 
to induce coftivenefs when the evacuation is 
over ; fo thofe purgatives which produce a 
large evacuation, are unfit for correfting the 
habit of coftivenefs. This^ therefore, ftiould 
be attempted by medicines which do no more 
than folicit the inteftines to a more ready dif- 
charge of their prefent contents, without either 
hurrying their a6lion, or increafing the excre- 
tions made into their cavity ; either of which 
cfFeas might produce a purging. There are, 
R 2 I think. 


1 think^ certain medicines peculiarly propef 
on this occafioni as they feem to flimulate efi. 
pecially the great guts, and to a6t little on the 
higher parts of the inteflinal canal. 


We have thus mentioned the feveral means 
"bP execuiing our fecond indication ; and I 
proceed to the ihirdy which is, as we have 
laid, the proper curative ; and it is to reflora 
the tone of the ftomach, the lofs of which w6 
confider as the proximate caufe of the dileafc', 
or at lead as the chief part of it. The means 
of fatisfying this indication we refer to two 
heads. One is, of thofe means which operate 
tiireftly and chiefly on the ftomach itfelf ; and 
the other is, of thofe means which^ operating 
upon the whole fyftem, have their tonic ef- 
fe6ls thereby communicated to the ftomach. 


The itiedicines which operate direftly on 
the ftomach, are either ftimulants or tonics. 

The ftimulants are faline or aromatic. 

The faline are acids or neutrals. 

Acids of all kinds feem to have the power 
of ftimulating the ftomach^ and therefore oft- 
en increafe appetite : But the native acids, as 
liable to fermentatioii,may otherwife do harm^ 
and are therefore of ambiguous ufe. The acids^ 
therefore, thietly and fuccefsfully employed, 
are the vitriolic, muriatic, and the diftilled acid 
of vegetables, as it is found in tar water, which- 
are all of them aiUizymics. 



The neutral falts anfwering this intention_, 
are efpecially thofe which have the muriatit 
acid in their compofition, though it is pre- 
ftiimed that oeutrals of all kinds have more oi 
lefs of the fame virtue. 


The aromatics, and perhaps fome other 
acrids, certainly flimulate the ftomach, a's 
they obviate the acefcency and flatulency of 
vegetable food : But their flimulus is tranfi- 
tory ; and if frequently repeated, and taken 
in large quantities, they may hurt the tone of 
the ftomach. 


The tonics employed to flrengthen the 
ftomach are bitters, bitters and aftringents 
combined, and chalybeates.. 

Bitters are undoubtedly tonic medicines, 
both -with refped to the ftomach and the whole 
fyftem : But their long continued ufe has 
been found to deftroy the tone of the ftom- 
ach, and of the whole fyftem ; and, whether 
this*isfrom the mere repetition of their tonic 
operation, or from fome narcotic power join- 
ed with. the tonic in them, I am uncertain. 


Bitters and aftringents combined, are, prob- 
ably, more eft"eaual tonics than either of them 
taken fmgly ; and we fuppofe fuch a com- 
bination to take place in the Peruvian bark ; 
which therefore proves a powerful tonic, both 


with refpeft to the flomach and to the whole 
fyftem. But I have fome ground to (ufpe^ii, 
that the long continued ufe of this bark may, 
like bitters, dcflroy both the tone of the flom- 
ach and of the whole fyftem. 


Chalybeates may be employed as tonics in 
various forms, imd in confiderable quantities:, 
with fafety. They have been often employ- 
ed in the form of mineral waters, and feem- 
ingly with fuccefs : But whether this is owing 
to the chalybeate in the compofition of thefe 
waters, or to fome other circumftances attend- 
ing their ufe, I dare not pofitively determine ; 
but the latter opinion feems to me the more 


The remedies which ftrengthen the ftom- 
ach, by being applied to the whole body, are, 
exercife and the application of cold. 

As exercife ftrengthens the whole body, it 
muft alfo ftrengthen the ftomach ; but it does 
this alfo in a particular manner, by promot- 
ing perfpiration, and exciting the a6lion of 
the velfels on the furface of the body, which 
have a particular confent with the mufcular 
fibres of the ftomach. This particularly ex- 
plains why the exercifes of geftation, though 
not the moft powerful in ftrengthening the 
whole fyftem, are, however, very powerful in 
ftrengthening the ftomach ; of which we have 
a remarkable proof in the eftedls of failing. 



In ftrengthening the general fyftem, as fatigue 
muft be' avoided, fo bodily exercife is of am- 
biguous ufe ; and perhaps it is thereby, that? 
riding on horfeback has been fo often found 
to be one of the moR powerful means ot 
ftrengthening the ftomach, and thereby of 
curing dyfpepfia. 


The other general remedy of dyfpepfia, is 
the application of cold : Which may be in 
two ways ; that is, either by the application 
of cold air, or of cold water. It is probable, 
that, in the atmofphere conftantly furround:- 
incr our bodies, a certain degree of cold, con- 
fiderably lefs than the temperature of out 
bodies themfelves, is neceffary to the healtfl 
of the human body. Such a degree of cold 
feems to ftrengthen the v^lfels on the luftace 
of the body, and therefore the mufcular fabres 
of the flomach. But, further, it is well known, 
that if the body is in exercife fufficient to lup- 
port fuch a determination to the lurface, as to 
prevent the cold from producing an entire 
condriaion of th« pores; a cenain degree ot 
cold in tlie. atmofphere, with fuch exercile, 
will render the perfpiration more conhder- 
able From the (harp appetite that in iucli 
circumilances is commonly produced, we can 
have no doubt, that by the application of 
fuch cold, the tone of the aomach is corihder 
ui , Avrncrthened. Cold air, theretoie, ap 
;KrifeK"v-re. is a n,oa powerful tornc 
? ith refpea to the^ilomach = and th.s e.plain» 



why, for that purpo.fe, no exerciXes withia 
doors, or in clofe carriages, are fo ufeful it^ 
t^ofe m the open air. 


From the fame reafoning, wc can perceive, 
that the application of cold water, or cold 
bathing, while it is a tonic with refpeft to the 
fyftem in general, and efpecially as exciting 
the a6lion of the extreme veffels, muft in both 
refpe61s be a powerful means of ftrengthening 
the tone of the ftomach. 


Thefe are the remedies to be employed to- 
wards a radical cure of idiopathic dyfpepfia ; 
and it might be, perhaps, expe6led here, that 
1 fhould treat alfo of the various cafes of the 
fympathic difeafe. But it will be obviotis that 
this cannot be properly done without treating 
of all the difeafes of which the dyfpepfia is a 
fymptom, which cannot be proper in this 
place. It has been partly done already, and 
will be further treated of in the courfe of this 
^v'ork. In the mean time, it may be proper 
to obfexve, that there is not fo much occafion 
for diflinguifhing between the idiopathic and 
fympathic dyfpepfia, as there is in many oth- 
er cafes of idiopathic and fympathic difeafes. 
For, as the fympathic cafes of dyfpepfia are 
owing to a lofs of tone in fome other part of 
tht fyftem, which is from thence communi- 
cated to the ftomach ; fo the tone of the ftom- 
ach reftored, may be communicated to the 


OF P H Y S" I C. 381 

part primarily afFeded ; and therefore the 
remedies of the idiopathic may be often ufc- 
fully employed, and are often the remedies 
chiefly employed, in fympathic dyfpepfia. 


Another part of oiir bufinefs here might be 
to fay, how fome other of the urgent fymp- 
toms, befides thofe above mentioned, are to be 
palliated. On this fubje6l, I think it is enougli 
to fay, that the fymptoms chiefly requiring 
to be immediately relieved, are flatulency, 
heartburn, other kinds ofpaininthe region 
of the Itomach, and vomiting. 

The dyfpeptic are read}^ to fuppofe that 
the whole of their difeafe confiflis in a flatu- 
lency. In this it vnil be obvious that they are 
mi (taken ; but, although the flatulency is not 
to be entirely cured, but by mending the im- 
becility of the ftomach by the means above 
mentioned ; yet the flatulent diftention of the 
ftomach may be relieved by carminatives, as 
they are called, or medicines that produce a 
difcharge of wind from the ftomach ; fuch arc 
the various antifpafmodics, of which the moft 
effeftual is the vitriolic aether. 

The heartburn may be relieved by abforb- 
ents, antifpafmodics, or demulcents. 

The other pains of the flomach may be 
fometimes relieved by carminatives, but mod 
certainly by opiates. 

Vomiting is to be cured moft efl^edtually by 
opiates thrown by injeaion into the anus. 

Vol. 2. R5 C H A p.. 


C H A P. III. 





1 N certain perfons there is a 
flate of mind diflinguilhed by a concurrence 
of the following circumftances : A languor, 
liftleflhefs, or want of refolution and aftivity 
with refpedl to all undertakings ; a difpofition 
to ferioufnefs, fadnefs, and timidity ; as to all 
future events, an apprehenfion of the word 
or moft unhappy flate of them ; and there- 
fore, often upon flight grounds, an apprehen- 
fion of great evil. Such perfons are particu- 
larly attentive to the flate of their own health, 
to every the fmallefl change of feeling in their 
bodies ; and from any unufual feeling, per- 
haps of the flighteft kind, they apprehend 
great danger, and even death itfelf. In ref- 
pe6l to all thefe feelings and apprehenfions, 
there is commonly the mofl obftinate belief 
and perfuafion. 


This flate of mind is the Hypochondriafis 
of medical writers. See Linnsei Genera Mot- 
bonim, Cen. '76. et Sagari Syflema Symp- 


OF PHYSIC. 38^. 

tomaticum, Clafs XIII. Gen. 5. The fame 
itate of mind is what has been commonly call- 
ed Vapours and Low Spirits. Though the- 
term Vapburs may be founded on a faife the- 
ory, and therefore improper, I beg leave, for 
a purpofe that will immediately appear, to. 
employ it for a little here. 


Vapours, then, or the (late of mind def— 
cribed above, is, like every other flate of mind, , 
conne6led with a certain ftate of the body, 
which mull be inquired into in order to its 
being treated as a difeafe by the art of phyfic. 


This (late of the body, however, is not very 
eafily afcertained : For we can perceive, that 
on different occafions it is very different ; va- 
pours being combined fometimes with dyf- 
pepfia, fometimes with hyfleria, and fome- 
times with melancholia, which are difeafes 
feemingly depending on very different dates 
of the body. 


The combination of vapours with dyfpepi 
fia is very frequent, and in feemingly very 
different circumftances. It is, efpecially, 
thefe different circumftanees that I would 
with to afcertain ; and I remark, that they are 
manifeftly of two different kinds. Firft, as 
the diCcafe occurs in young perfons of botliJ 
R 6 fexe.s, 


fexcs, in perfons of a fangulne temperament, 
and of a lax and flaccid habit. Secondl)-^ as 
it occurs in .elderly perfons of both fcxes, of 
a melancholic temperament, and of a firm 
and rigid habit. 


Thefe two diflPerent cafes of the combina- 
tion of vapours and dyfpepfia, I confider as 
two diflinft difeafes, to be diftinguiflicd chief- 
ly by the temperament prevailing in the per- 
fons afFe6led. 

As the dyfpepfia of fanguine temperaments 
is often without vapours ; and as the vapours, 
when joined with dyfpepfia in fuch tempera- 
ments, may be confidered as, perhaps, always 
a fymptom of the afFeftion of the ftomach ; 
fo to this combination of dyfpepfia and va- 
pours, I would ftill apply the appellation of 
Dxfpepfiay and confider it as finally the dif* 
cafe treated of in the preceding chapter. 

But the com.bination of dyfpepfia and va- 
pours in melancholic temperaments, as the 
vapours or the turn of mind peculiar to the 
temperament, nearly that defcribed above in 
MCCXXII, are eficntial circumflances of the 
difeafe ; and as this turn of mind is often with 
few, or only flight fymptoms of dyfpepfia ; 
and, even though the latter be attending, as 
they feem to be rather the eflFe6ls of the gen- 
eral temperament, than of any primary or 
topical affcftion of the ftomach ; 1 confider 
thi^ combinatioia as a vtry different difeafe 



from the former, and would apply ilri^ 
ly the appellation of Hypochondriafu. 


Having thus pointed out a diflin6lion be-, 
tween Dyfpepfia and Hypochondriafis, I (hall 
now, ufmg thefe terms in the ftrift fenfe above 
mentioned, make fome obfervations which 
may, I thmk, illuftrate the fubjeft, and more 
clearly and fully eftablifh the diftindion pro- 


The dyfpepfia often appears early in life, 
and is frequently much mended as life ad- 
vances : But the hypochondriafis feldom ap- 
pears early in life, and more ufually in more 
advanced years only ; and more certainly flill, 
when it has once taken place, it goes on in- 
creafing as life advances to old age. 

This feems to be particularly well illuflraf- 
ed, by our obferving the changes in the ftate 
of\he mind wJiich ufually take place in the 
courfe of life. In youth, the mind is cheer- 
ful, aftive, rafh, and moveable : But as life 
advances, the mind by degrees becomes more 
ferious, flow, cautious, and ftcady ; till at 
length, in old age, the gloomy, timid, diftruft- 
ful.'^and obftinate flate of melancholic temper- 
aments, is more exquifitely formed. In pro- 
ducing thefe changes, it is true, that moral 
caufes have a fliare ; but it is at the fame time 
obvious, that the temperament of the body 
determines the operation of thefe moral caul- 



es, foon€r or later, and in a greater or lefifer 
degree, to have their eEFe6ls. The fanguine 
temperament retains longer the chara6ler ot 
youth, while the melancholic temperament 
brings on more early the manners of old age. 


Upon the whole, it appears, that the ftate of 
the mind which attends, and efpecially diftin- 
guifhes hypochondriafis, is the efFeft of that 
fame rigidity of the folids, torpor of the ner- 
vous power, and peculiar balance between the . 
arterial and venous fyftems which occur in 
advanced life, and which at all times take, 
place more or lefs in melancholic tempera- 
ments. If therefore there be alfo fomewhat 
of a like flate of mind attending the dyfpep- 
fia which occurs early in life* in fanguine tem- 
peraments and lax habits, it mull depend up- 
on a different flate of the body, and probably, 
upon a weak and moveable flate of the ner- 
vous power. s 


Agreeable to all this, in dyfpepfia, there is 
more of fpalmodic afiFedlion, and the affection 
of the mind (M OCX XI I) is often abfent, and, 
when prefent, is perhaps always of a flighter 
kind : While, in hypochondriafis, the affec- 
tion of the mind is more conflant, and the 
fymptoms of dyfpepfia, or the affedions of 
the flomach, are often abfent, or, .when pref- 
ent, are in a flighter degree. 

I believe 


I believe the afFeftion of the mind is com- 
monly different in the two difeaies. In dyf- 
pepfia, it is often languor and timidity only, 
cafily difpelled ; while in hypochondriafis, it 
is generally the gloomy and rivetted appre- 
henfion of evil. 

The two difeafcs are alfo diftinguiflied by 
fome other circumflances. Dyfpepfia, as I 
have faid, is often a fymptomatic affe6lion ; 
while hypochondriafis is, perhaps, always a 
primary and idiopathic diieafe. 

As debility may be induced by many dif- 
ferent caufes, dyfpepfia is a frequent difeafe ; 
while hypochondriafis, depending upon a pe- 
culiar temperament, is more i^are. 


Havincfthus endeavoured to diftinguifh the 
two difeafes, I fuppofe the peculiar nature and 
proximate caufe of hypochondriafis will be 
underftood ; and I proceed therefore to treat 

of its cure. 

So far as the affeaions of the body, and par- 
ticularly of the ftomach, are the fame here as 
in the cafe of dyfpepfia, the method of cure 
mi<rht be fuppofed to be alfo the fame ; and 
acc^'ordingly the pradice has been carried on 
with little diftinaion : But I am perfuaded 
that a diftinaion is often neceffary. 


There may be a foundation here for the 
fame prcfervativc mdication as firft laid down 


in the cure of dyfpepfiia (MCCII) ; but E can- 
not treat this fubjell fo clearly or fully as I 
could wifti, becauie I have not yet had fo 
Httuch opportunity of obfervation as I think 
neceffary to aicertain the remote caufes • and 
I can hardly make ufe of the obfervations of 
others, who have feldom or never diftinguifh- 
ed between the two difeafes. What, indeed, 
has been faid with refpedl to the remote cauf- 
es of melancholia^ will often apply to the Ay- 
pochondriafiSy which I now treat of; but the 
tubjet^l of thii foiTner has been fo much in- 
volved in a doubtful theory, that I find it dif- 
ficult to felc6l the fafls that might properly 
and ftri6lly apply to the latter. I delay this 
fubjeft, therefore, till another occafion ; but 
in the mean time truft, that what I have faid 
regarding the nature of the difeafe, and fome 
remarks I fhall have occafion to offer in con- 
fidering the method of cure, may in fome 
meafure fupply my deficiency on this fubje6l 
of the remote caulcs. 


The/ccond indication laid down in the cure 
of dyfpepfia (MCCI) has properly a plicc 
here ; but it is fi.ill to be executed with fome 


An anorexia, and accumulation of crudities 
in the ftomach, does not fo commonly occur 
in hypochondriafis as in dj^fpepfia ; and there- 
fore vomiting (MCCiV) is r»ot fo oFren nec- 
effary in the former as in the latter. 




The fymptom of excefs of acidity, from the 
flow evacuation of the ftomach in melanchol- 
ic temperaments,, often arifes to a very high 
degree in hypochondria fis ; and therefore, for 
the fame reafon- as in MCCV, it is to be ob- 
viated and correfled with the utmoft care. 
It is upon this account that the feveral an- 
tacids, and the other means of obviating acid- 
ity, are to be employed in hypochondriacs, 
and with the fame attentions and confidera- 
tions as in MCCV I, and following ; with this 
reflexion, however, that the exciting the ac- 
tion of the ftomach there mentioned, is to be 
a litde differently underftood,,as Ihall be here- 
after explained. 


As coftivenefs, and that commonly to a 
confiderable degree, is a very conftant attend- 
ant of hypochondria fis, fo it is equally hurt- 
ful as in dyfpepfia. It may be remedied by 
the fame means in the former as in the latter, 
and they are to be employed with the fame 
reftriftions as in MCCX. 


It is efpecially with refpea to the third in- 
dication laid down in the cure of dyfpeplia 
fMCCI), that there is a difference of prattice 
to be obferved in the cure of hypochondria is ; 
and that often one diredly oppofite to that in 
the cafe of dvfpepfia, is to be followed. 




In dyfpepfia, the chief remedies are the to- 
nic medicines, which to me feem neither nec- 
efTary nor fafe in hypochondriafis ; for in this 
there is not a lofs of tone, but a want of aftiv- 
ity that is to be remedied. 

Chalybeate mineral waters have commonly 
been employed in hypochondriafis, and feem- 
ingly with fuccefs. But this is probably to 
be imputed to the amufement and exercife 
ufually accompanying the ufe of thefe waters, 
rather than to the tonic power of the fmall 
quantity of iron which they contain. Per- 
haps the elementary water, by favouring the 
excretions^ may have a fhare in relieving th,e 


Cold bathing is often highly ufeful to the 
dyfpeptic, and, as a general ftimulant, may 
fometinies feem. ufeful to the hypochondriac ; 
but it is not commonly fo to the latter ; while,, 
on the other hand, warm bathing, hurtful to 
the dyfpeptic, is often extremely ufeful to the 


Another inftance of a contrary pra6i;ice 
neceffary in the two difeafes, and illuflrating 
their refpeftive natures, is, that the drinking, 
tea and coffee is always hurtful to the dyf- 

O T P H Y S I C. 391 

peptic, but is commonly extremely ufeful to 
the hypochondriac. 


Exercife, as it ftrengthens the fy flem, and 
thereby the ftomach, and more efpecially, as, 
by incrcafing the perfpiration, it excites the 
aftion of the ftomach, it proves one of the 
moft ufeful remedies in dyfpepfia j and fur- 
ther, as, by increafmg the perfpiration, it ex- 
cites the activity of the ftomach, it likewife 
proves an ufeful remedy in the hypochondri- 
afis. However, in the latter cafe, as I ftiaU 
explain prefently, it is ftill a more ufeful rem- 
edy by its operation upon the mind than by 
that upon the body. 


It is now proper that we proceed to con- 
fider the moft important article of our prac- 
tice in this difeale, and which is, to confider 
the treatment of the mind ; an aflfeftion of 
which fometi.nes attends dyfpepfia, but is al- 
ways the chief circumftance in hypochondria- 
fis. What I am to fuggeft here, will apply 
to both difeafes ; but it is the hypochondriafis 
that I am to keep moft conftantly in view. 


The management of the mind, in hypo- 
chondriacs, is often nice and difficult. The 



firm perfuafion that generally prevaik in hixh 
patients, does not allow their feelings to be 
treated as imaginary, nor their apprehenfion 
of danger to be coiilidered as groundlefs, 
though the phyfician may be perfuaded that 
it is the cafe in both refpe^ls. Such patients, 
therefore, are not to be treated either by raili 
lery or by reafoning. 

It is faid to be the manner of hypochon- 
driacs to change often their phyfician ; and 
indeed they often do it confiftentJy : For a 
phyfician who does not admit the reality of 
the difeafe, cannot be fuppofed to take much 
pains to cure it, or to avert the danger of 
which he entertains no apprehenfion. 

If in any cafe the pious fraud of a placebo 
be allowable, it feems to be in treating h}^o- 
chondriacs ; who, anxious for relief, are fond 
of medicines, and, though often difappointed, 
will flill take every new drug that can be pro- 
pofed to them. 


As it is the nature of man to indulge every 
prefent emotion, fo the hypochondriac cher- 
ifhes his fears, and, attentive to every feeling, 
finds in trifles light as air a (Irong confirma- 
tion of his apprehenfions. His cure there- 
fore depends efpecially upon the interrup- 
tion of his attention, or upon its being di- 
verted to other objects than his own feel-, 




Whatever averfion to application of any- 
"kind may appear in hypochondriacs, there is 
nothing more pernicious to them than abCo- 
lute idlenefs, or a vacancy from all earneft 
purfuit. It is owing to wealth admitting of 
indolence, and leading to the purfuit of tran- 
fitory and unfatisfying amufements, or to 
that of exhaufting pleafunes only, that the 
prcfent times exhibit to us fo many inllances 
of hypochondriacifm* 

The occupations of bufinefs fuitable to 
their circumftances and fituation in life, if 
neither attended with emotion, anxiety, nor 
fatigue, are always to be admitted, and per- 
fifted in by hypochondriacs. But occupas. 
tions upon which a man's fortune depends^ 
and which are always therefore, obje6ls of 
anxiety tt) melancholic men j and more par- 
ticularly where fuch occupations are expofed 
to accidental interruptions^ difappointments, 
and failures, it is from thefe that the hypo- 
chondriac is certainly to be withdrawn. 


The "hypochondriac who is not neceffarily-, 
by circumftances or habits, engaged in buli^ 
nefs, is to be drawn from his attention to hift 
own feelings by fome amufement 

The various kinds of fport and huntmg, as 
tiurfucd'with fome ardor, and attended with 
^ exercilci 



exercife, if not too violent, are amongfl the 
moft ufeful. 

All thofe amufements which are in the 
open air, joined with moderate exercife, and 
requiring Ibme dexterity, are generally of ufe. 

Within doors, company which engages at- 
tention, which is willingly yielded to, and is 
at the fame time of a cheerful kind, will be 
always found of great fervice. 

Play, in which fome {kill is required, and 
where the flake is not an obje6l of much 
anxiety, if not too long protratlied, may often 
be admitted. 

In dyfpeptics, however, gaming, lia-ble to 
fudden and confiderable emotions, is danger- 
ous ; and the long continuance of it, with 
night watching, is violently debilitating. But 
in melancholies, who commonly excel in Ikill, 
and are lefs fufceptible of violent emotions, 
it is more admiflibl&. and is often the only 
amufement -that can engage them. 

Mufic, to a nice ear, is a hazardous amufe- 
ment, as long attention to it is very fatiguing, 


It frequently happens, that amufements of 
every kind are rejeded by hypochondriacs ; 
and in that cafe, mechanical means of inter- 
rupting thought are the remedies to be fought 

Such is to be found in briflc exercife, which 
requires fome attention in the condu^ of it. 



;. Walking is feldom of this kind j though, as 
gratifying to the reftlefTnefs of hypochondria 
acs, it has fomctimes been found ufeful. 

The required interruption of thought is 
beft obtained by riding on horfeback, or in 
driving a carrifage of any kind. 

The exercife of failing, except it be in an 
Qpen boat, engaging fome attention, does very- 
little fervice. 

Exercife in an eafy carriage, in the diredion 
of which the traveller takes no part, unlefs it 
be upon rough roads, or driven pretty quick- 
ly, and with long continuance, is of little ad- 


Whatever exercife may be employed, it 
will be moft effe6lual when employed in the 
purfuit of a journey ; firfV, becaufe it with- 
draws a perfon from many objefts of uneafi- 
nefs and cate which might prefent themfelves 
at home ; fccondly, as it engages in more con- 
ftant exercife, and in a greater degree of it 
than is commonly taken in airings about 
home ; and, laftly, as it is conftantly prefent- 
ing new obj efts which" call forth a perfon's 


in our fyftetii of Nofology we have next 
to Hypochondriafis, placed the C^l^^^^^'j^^^j.; 



caufe I once thought it might be coftfidere(! 
as a genus, comprehending, befides the Chlo- 
rofis of Amenorrhcca, fome Ipecies of Ga* 
chexy : But, as I cannot find this to be well 
founded, and cannot diflin^lly point out any 
fuch difeafe, I now omit confidering Chloro- 
fis ag a genus here ; andj as a fymptom of 
Amenorrhoea, I have endeavoured before to 
explain it under that title. 



% OF VOL. II. § 




• • ARMY * *